Provider Demographics
NPI:1962976753
Name:FAMILY WELLNESS COUNSELING
Entity type:Organization
Organization Name:FAMILY WELLNESS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-822-7635
Mailing Address - Street 1:8211 E REGAL PL STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7181
Mailing Address - Country:US
Mailing Address - Phone:918-604-2007
Mailing Address - Fax:
Practice Address - Street 1:8211 E REGAL PL STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7181
Practice Address - Country:US
Practice Address - Phone:918-604-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty