Organization
ABUNDANT LIFE TODAY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MICHAEL KISSICK LPC, LADC, BCPCC (DIRECTOR)
(405) 340-0085
Entity
Organization
Contact information
Practice address
4000 E CHARTER OAK ROAD, GUTHRIE, OK 73044-9263
(405) 340-0085
(866) 941-8550
Mailing address
4000 E CHARTER OAK ROAD, GUTHRIE, OK 73044-9263
(405) 340-0085
(866) 941-8550
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4707
OK
Other
Enumeration date
11/26/2014
Last updated
11/26/2014
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