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513 S Willow St Pauls Valley OK 73075-3849 | |
| (405) 926-2085 | |
| (405) 926-2089 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 513 S Willow St, Pauls Valley, Oklahoma |
| Authorized Official Name and Position | Randy Hugh Gardenhire (CEO) |
| Authorized Official Contact | 5803993071 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 826 Pauls Valley OK 73075-0826 Ph: (405) 926-2085 | 513 S Willow St Pauls Valley OK 73075-3849 Ph: (405) 926-2085 |
| NPI Number | 1104295500 |
|---|---|
| Provider Enumeration Date | 09/16/2015 |
| Last Update Date | 09/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104295500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5643 (Oklahoma) | Primary |
| 106H00000X | Marriage & Family Therapist | 1147 (Oklahoma) | Secondary |
Journey Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 524 S Chickasaw St, Pauls Valley, OK 73075 Phone: 580-320-2906 | |
Lighthouse Behavioral Wellness Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 S Willow St, Pauls Valley, OK 73075 Phone: 580-223-5070 Fax: 580-223-5617 | |
Lighthouse Behavioral Wellness Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 S Willow St, Pauls Valley, OK 73075 Phone: 405-238-7311 Fax: 405-238-3530 |