Provider Demographics
NPI:1831664077
Name:HEART MIND & SOUL COUNSELING AGENCY
Entity Type:Organization
Organization Name:HEART MIND & SOUL COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRIPR
Authorized Official - Middle Name:STEMMONS
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-319-5264
Mailing Address - Street 1:301 W MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6322
Mailing Address - Country:US
Mailing Address - Phone:580-319-5264
Mailing Address - Fax:844-769-4938
Practice Address - Street 1:301 W MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6322
Practice Address - Country:US
Practice Address - Phone:580-319-5264
Practice Address - Fax:844-769-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty