Provider Demographics
NPI:1801073028
Name:CENTER FOR COUNSELING CARE OF OKLAHOMA
Entity type:Organization
Organization Name:CENTER FOR COUNSELING CARE OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER REDBUD FAMILY COUNSELING
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LMFT CEAP
Authorized Official - Phone:405-942-4308
Mailing Address - Street 1:4334 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-942-4308
Mailing Address - Fax:405-942-6011
Practice Address - Street 1:4334 NW EXPRESSWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-942-4308
Practice Address - Fax:405-942-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1284101YP2500X
OK715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty