Provider Demographics
NPI:1831488436
Name:MAKING AN IMPACT COUNSELING SERVICES
Entity Type:Organization
Organization Name:MAKING AN IMPACT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:SHAREE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, BHRS, CMII
Authorized Official - Phone:405-824-1871
Mailing Address - Street 1:3140 W BRITTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2074
Mailing Address - Country:US
Mailing Address - Phone:405-608-4425
Mailing Address - Fax:405-608-4428
Practice Address - Street 1:3140 W BRITTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2074
Practice Address - Country:US
Practice Address - Phone:405-608-4425
Practice Address - Fax:405-608-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management