Provider Demographics
NPI:1063946168
Name:COMMUNITY COUNSELING OF OWASSO, LLC
Entity type:Organization
Organization Name:COMMUNITY COUNSELING OF OWASSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-636-5234
Mailing Address - Street 1:10306 N 138TH EAST AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4665
Mailing Address - Country:US
Mailing Address - Phone:918-636-5234
Mailing Address - Fax:
Practice Address - Street 1:10306 N 138TH EAST AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4665
Practice Address - Country:US
Practice Address - Phone:918-636-5234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200546520AMedicaid