Provider Demographics
NPI:1215426465
Name:COUNSELING DYNAMICS AND RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:COUNSELING DYNAMICS AND RECOVERY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NDUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-408-4366
Mailing Address - Street 1:5319 E 95TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4423
Mailing Address - Country:US
Mailing Address - Phone:918-408-4366
Mailing Address - Fax:
Practice Address - Street 1:5350 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6612
Practice Address - Country:US
Practice Address - Phone:918-408-4366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty