Individual
MRS. AMBER NICHOLE SULLIVAN MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
2617 GENERAL PERSHING BLVD, OKLAHOMA CITY, OK 73107-6437
(405) 858-1700
Mailing address
PO BOX 12978, OKLAHOMA CITY, OK 73157-2978
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
5404
OK
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
5404
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4505
COUNSELOR- MENTAL HEALTH
OK
Enumeration date
06/09/2012
Last updated
12/14/2020
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