Provider Demographics
NPI:1972604171
Name:MARIPOSA COUNSELING, INC.
Entity Type:Organization
Organization Name:MARIPOSA COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-326-8945
Mailing Address - Street 1:1922 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5605
Mailing Address - Country:US
Mailing Address - Phone:405-326-8935
Mailing Address - Fax:405-735-5265
Practice Address - Street 1:1922 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5605
Practice Address - Country:US
Practice Address - Phone:405-326-8935
Practice Address - Fax:405-735-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty