Provider Demographics
NPI:1942614631
Name:MEHERRIN RIVER COUNSELING SERVICES
Entity Type:Organization
Organization Name:MEHERRIN RIVER COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-492-4604
Mailing Address - Street 1:45042 COUNTY STREET 2680
Mailing Address - Street 2:
Mailing Address - City:CYRIL
Mailing Address - State:OK
Mailing Address - Zip Code:73029-2111
Mailing Address - Country:US
Mailing Address - Phone:434-848-5178
Mailing Address - Fax:580-492-4609
Practice Address - Street 1:9201 STATE HIGHWAY 17 STE A
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-4517
Practice Address - Country:US
Practice Address - Phone:434-848-5178
Practice Address - Fax:580-492-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124216577Medicaid
OK1124216577Medicaid
1942614631OtherCOMPANY NPI