| Edmondson Counseling Services, Pc | |
|
5009 N Pennsylvania Ave Ste. 116 Oklahoma City OK 73112-8887 | |
| (405) 843-1551 | |
| (405) 843-1494 |
| Full Name | Edmondson Counseling Services, Pc |
|---|---|
| Speciality | Counselor |
| Location | 5009 N Pennsylvania Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Connie Cunningham Edmondson (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4058431551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edmondson Counseling Services, Pc 5009 N Pennsylvania Ave Ste. 116 Oklahoma City OK 73112-8887 Ph: (405) 843-1551 | Edmondson Counseling Services, Pc 5009 N Pennsylvania Ave Ste. 116 Oklahoma City OK 73112-8887 Ph: (405) 843-1551 |
| NPI Number | 1447328489 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 06/17/2011 |
| Medicare PECOS PAC ID | 6800946831 |
|---|---|
| Medicare Enrollment ID | O20090611000654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447328489 | NPI | - | NPPES |
| 448602140002 | Other | OK | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1508 (Oklahoma) | Primary |
| Provider Name | Brian T Edmondson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407020555 PECOS PAC ID: 0547320020 Enrollment ID: I20081114000253 |
| Provider Name | Connie Edmondson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730199167 PECOS PAC ID: 2365592490 Enrollment ID: I20090611000640 |
| Provider Name | Elissa M Dyer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801029715 PECOS PAC ID: 1658559646 Enrollment ID: I20110622000058 |
| Provider Name | Andrea Nicole Caplinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376894121 PECOS PAC ID: 0547419970 Enrollment ID: I20120928000624 |
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