Provider Demographics
NPI: | 1407438930 |
---|---|
Name: | AHNI WAKAYA COUNSELING & CONSULTING INC |
Entity type: | Organization |
Organization Name: | AHNI WAKAYA COUNSELING & CONSULTING INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CLINICAL DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NELLIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MEASHINTUBBY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC LADC |
Authorized Official - Phone: | 918-470-4260 |
Mailing Address - Street 1: | 301 E MAIN ST STE 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | WILBURTON |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74578-4415 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-470-4260 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 301 E MAIN ST STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | WILBURTON |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74578-4415 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-470-4260 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-04-23 |
Last Update Date: | 2021-04-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |