Organization
CANADIAN COUNTY COLLABORATIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT PIERCE LPC, RPTS (THERAPIST)
(405) 805-6203
Entity
Organization
Contact information
Practice address
1703 PROFESSIONAL CIR STE 201, YUKON, OK 73099-6498
(405) 805-6203
(405) 896-4151
Mailing address
10616 SW 35TH ST, YUKON, OK 73099-0445
(405) 805-6203
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200434450A
—
OK
Enumeration date
06/26/2020
Last updated
06/26/2020
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