Provider Demographics
NPI:1285103796
Name:ALTUS FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:ALTUS FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LORAH
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:580-379-0677
Mailing Address - Street 1:1116 N MAIN ST STE M12
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3149
Mailing Address - Country:US
Mailing Address - Phone:580-379-0677
Mailing Address - Fax:580-482-0008
Practice Address - Street 1:1116 N MAIN ST STE M12
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3149
Practice Address - Country:US
Practice Address - Phone:580-379-0677
Practice Address - Fax:580-482-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty