Provider Demographics
NPI:1427546514
Name:INTERNAL CONNECTIONS PLLC
Entity type:Organization
Organization Name:INTERNAL CONNECTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:580-512-7753
Mailing Address - Street 1:1303 W GORE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3666
Mailing Address - Country:US
Mailing Address - Phone:508-512-0193
Mailing Address - Fax:866-292-0710
Practice Address - Street 1:1303 W. GORE BLVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3666
Practice Address - Country:US
Practice Address - Phone:580-512-7753
Practice Address - Fax:866-292-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5664251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health