Provider Demographics
NPI:1427369057
Name:WOHL'S COUNSELING CLINIC,LLC
Entity type:Organization
Organization Name:WOHL'S COUNSELING CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WOHL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-762-6511
Mailing Address - Street 1:400 E CENTRAL AVE
Mailing Address - Street 2:STE.303E
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-5429
Mailing Address - Country:US
Mailing Address - Phone:580-762-6511
Mailing Address - Fax:580-762-6511
Practice Address - Street 1:400 E CENTRAL AVE
Practice Address - Street 2:STE.303E
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-5429
Practice Address - Country:US
Practice Address - Phone:580-762-6511
Practice Address - Fax:580-762-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094600AMedicaid