Provider Demographics
NPI:1851821466
Name:LIFT PROFESSIONAL COUNSELING CO.
Entity Type:Organization
Organization Name:LIFT PROFESSIONAL COUNSELING CO.
Other - Org Name:LIFT PROFESSIONAL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOATE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-315-4350
Mailing Address - Street 1:3700 N CLASSEN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2882
Mailing Address - Country:US
Mailing Address - Phone:405-342-0714
Mailing Address - Fax:
Practice Address - Street 1:101 PARK AVE
Practice Address - Street 2:STE 1300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-342-0714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)