| Organization Name: | FUNDAMENTALS COUNSELING SERVICES,LLC |
| NPI Number: | 1659781649 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMY RUSK (EXECUTIVE DIRECTOR) |
| Mailing Address: | 747 Hwy 59 #4 Westville |
| State: | OK US |
| Postal Code: | 74965 |
| Phone Number: | 9187233735 |
| Fax Number: | 9187233730 |
| NPI Enumeration Date: | 04/30/2014 |
| NPI Last Update Date: | 04/30/2014 |
| 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: | |