Organization Name: | BROKEN ARROW COUNSELING SERVICES LLC |
NPI Number: | 1033521851 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRISTINE BRENDA BOLLEY (OWNER) |
Mailing Address: | 1175 S Aspen Ave Suite J Broken Arrow |
State: | OK US |
Postal Code: | 740124800 |
Phone Number: | 9188502747 |
Fax Number: | |
NPI Enumeration Date: | 05/28/2014 |
NPI Last Update Date: | 05/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |