Organization
DISTINCTIVE ADOLESCENT AND ADULT GUIDANCE COUNSELING SERVICES
Active
Organization
DISTINCTIVE ADOLESCENT AND ADULT GUIDANCE COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH A GRAY LPC (OWNER)
(405) 812-8623
Entity
Organization
Contact information
Practice address
2119 RIVERWALK DR # 218, MOORE, OK 73160-2700
(405) 812-8623
Mailing address
2119 RIVERWALK DR # 218, MOORE, OK 73160-2700
(405) 812-8623
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4096
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100735950
—
OK
Enumeration date
11/04/2009
Last updated
11/04/2009
Update your record
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