Provider Demographics
NPI:1124275805
Name:PHYLLIS VANHEMERT, M.ED., INC.
Entity type:Organization
Organization Name:PHYLLIS VANHEMERT, M.ED., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUSBAND
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHEMERT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:405-314-6884
Mailing Address - Street 1:3855 S BOULEVARD ST
Mailing Address - Street 2:SUITE. 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5498
Mailing Address - Country:US
Mailing Address - Phone:405-340-4321
Mailing Address - Fax:405-340-9408
Practice Address - Street 1:3855 S BOULEVARD ST
Practice Address - Street 2:SUITE. 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5498
Practice Address - Country:US
Practice Address - Phone:405-340-4321
Practice Address - Fax:405-340-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1404OtherLICENSED PROFESSIONAL COUNSELOR