Provider Demographics
NPI:1396236477
Name:VIVACITY COUNSELING, PLLC
Entity type:Organization
Organization Name:VIVACITY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LPC
Authorized Official - Phone:405-365-5082
Mailing Address - Street 1:2013 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1617
Mailing Address - Country:US
Mailing Address - Phone:405-365-5082
Mailing Address - Fax:
Practice Address - Street 1:1211 N SHARTEL AVE STE 405
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2425
Practice Address - Country:US
Practice Address - Phone:405-977-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty