Provider Demographics
NPI:1700168994
Name:COUNSELING SERVICES OF LEFLORE COUNTY
Entity Type:Organization
Organization Name:COUNSELING SERVICES OF LEFLORE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-649-0772
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1335
Mailing Address - Country:US
Mailing Address - Phone:918-649-0772
Mailing Address - Fax:
Practice Address - Street 1:605 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462
Practice Address - Country:US
Practice Address - Phone:918-967-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNSELING SERVICES OF LEFLORE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
OK4265251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health