Provider Demographics
NPI:1962182568
Name:COLLECTIVE COUNSELING GROUP, LLC
Entity type:Organization
Organization Name:COLLECTIVE COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCHAREN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:405-259-6388
Mailing Address - Street 1:11158 LARKIN LN
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3824
Mailing Address - Country:US
Mailing Address - Phone:808-352-7595
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 550
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4538
Practice Address - Country:US
Practice Address - Phone:405-259-6388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty