Provider Demographics
NPI:1952976581
Name:RESILIENCE FROM ADDICTION
Entity Type:Organization
Organization Name:RESILIENCE FROM ADDICTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:405-863-0129
Mailing Address - Street 1:4330 ADAMS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1007
Mailing Address - Country:US
Mailing Address - Phone:405-863-0129
Mailing Address - Fax:405-310-2081
Practice Address - Street 1:4330 ADAMS RD STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1007
Practice Address - Country:US
Practice Address - Phone:405-863-0129
Practice Address - Fax:405-310-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty