Organization
CHRISTIAN CLINIC FOR COUNSELING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J RONALD CRUSE PH.D. (OWNER)
(405) 942-8888
Entity
Organization
Contact information
Practice address
3832 N MERIDIAN AVE, OKLAHOMA CITY, OK 73112-2820
(405) 928-8888
(999) 999-9999
Mailing address
2311 KILEY WAY, EDMOND, OK 73034-3428
(405) 942-8888
(999) 999-9999
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
156
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203851000
MAGELLAN HEALTH SERVICES
OK
Enumeration date
01/09/2007
Last updated
07/08/2014
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