Provider Demographics
NPI:1811458037
Name:COLLABORATIVE COUNSELING OF ENID
Entity type:Organization
Organization Name:COLLABORATIVE COUNSELING OF ENID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUNSON-BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MCP, LPC
Authorized Official - Phone:580-231-7099
Mailing Address - Street 1:301 W. MAINE, SUITE 100
Mailing Address - Street 2:301 W. MAINE, SUITE 100
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5669
Mailing Address - Country:US
Mailing Address - Phone:580-231-7099
Mailing Address - Fax:580-540-9819
Practice Address - Street 1:301 W. MAINE, SUITE 100
Practice Address - Street 2:301 W. MAINE, SUITE 100
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5699
Practice Address - Country:US
Practice Address - Phone:580-231-7099
Practice Address - Fax:580-540-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1851515407OtherNPI