Provider Demographics
NPI:1891920534
Name:NORMAN ADDICTION AND COUNSELING CENTER
Entity Type:Organization
Organization Name:NORMAN ADDICTION AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HENNE
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CADC
Authorized Official - Phone:405-321-0022
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0730
Mailing Address - Country:US
Mailing Address - Phone:405-321-0022
Mailing Address - Fax:405-360-4918
Practice Address - Street 1:215 W LINN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5837
Practice Address - Country:US
Practice Address - Phone:405-321-0022
Practice Address - Fax:405-360-4918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORMAN ADDICTION AND COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1629130166251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency