Organization
WETHRIVE COUNSELING CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARI SAMUELSON LCSW (OWNER/THERAPIST)
(918) 809-4841
Entity
Organization
Contact information
Practice address
416 E B ST APT A, JENKS, OK 74037-4157
(918) 809-4841
Mailing address
416 E B ST APT A, JENKS, OK 74037-4157
(918) 809-4841
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4509
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164767496
INDIVIDUAL NPI
—
Enumeration date
09/10/2017
Last updated
07/21/2022
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