Provider Demographics
NPI:1356788418
Name:SEQUOYAH COUNSELING SERVICES OF OKLAHOMA, INC.
Entity type:Organization
Organization Name:SEQUOYAH COUNSELING SERVICES OF OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COULBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:918-635-5082
Mailing Address - Street 1:210 OAK ST
Mailing Address - Street 2:PMB 300
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2505 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2050
Practice Address - Country:US
Practice Address - Phone:918-635-5082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management