Organization
LOGAN COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICHOLE D GRAVES LPC, LADC (CLINICAL DIRECTOR)
(405) 282-5524
Entity
Organization
Contact information
Practice address
4710 S DIVISION ST, GUTHRIE, OK 73044-6506
(405) 282-5524
Mailing address
PO BOX 1558, GUTHRIE, OK 73044-1558
(405) 282-5524
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100733910A
—
OK
Enumeration date
03/26/2007
Last updated
07/21/2022
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