Provider Demographics
NPI:1841475977
Name:INTERACTION COUNSELING
Entity type:Organization
Organization Name:INTERACTION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:580-353-0909
Mailing Address - Street 1:4411 W GORE BLVD STE B10
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-353-0909
Mailing Address - Fax:
Practice Address - Street 1:4411 W GORE BLVD STE B10
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-353-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK500522083OtherMEDICARE GROUP IDENTIFIER
OK500522083Medicare PIN