Provider Demographics
NPI:1386992394
Name:SOUTHEASTERN OKLAHOMA COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:SOUTHEASTERN OKLAHOMA COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:ELIFRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:918-413-4840
Mailing Address - Street 1:301 JOY DR
Mailing Address - Street 2:
Mailing Address - City:BOKOSHE
Mailing Address - State:OK
Mailing Address - Zip Code:74930-2504
Mailing Address - Country:US
Mailing Address - Phone:918-413-4840
Mailing Address - Fax:918-649-0404
Practice Address - Street 1:205 DEWEY AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4224
Practice Address - Country:US
Practice Address - Phone:918-413-4840
Practice Address - Fax:918-649-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2430251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1154526432Medicaid