Provider Demographics
NPI:1912159328
Name:CLIBURN COUNSELING AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:CLIBURN COUNSELING AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-LICENSED PROFESSIONAL THERAPT
Authorized Official - Prefix:MS
Authorized Official - First Name:B.
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:CLIBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PROFESSIONA
Authorized Official - Phone:405-306-1883
Mailing Address - Street 1:PO BOX 5613
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5613
Mailing Address - Country:US
Mailing Address - Phone:405-306-1883
Mailing Address - Fax:405-475-1721
Practice Address - Street 1:13810 CROSSING WAY E
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4720
Practice Address - Country:US
Practice Address - Phone:405-306-1883
Practice Address - Fax:405-475-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2473OtherSTATE OF OKLAHOMA, DEPT OF HEALTH, LICENSURE DIVISION FOR LICENSED PROFESSIONA