Organization
BEHAVIORAL MODIFICATION COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANNA HALCOMB LPC-S (COUNSELOR)
(918) 808-1000
Entity
Organization
Contact information
Practice address
4308 E 21ST PL, TULSA, OK 74114-2114
(919) 808-1000
Mailing address
4308 E 21ST PL, TULSA, OK 74114-2114
(919) 808-1000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4203
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200375600A
—
OK
Enumeration date
11/17/2016
Last updated
11/17/2016
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