| Life Vision Counseling Services, Pllc | |
|
3035 Nw 63rd St 230 Oklahoma City OK 73116-3632 | |
| (405) 242-5342 | |
| (405) 529-6972 |
| Full Name | Life Vision Counseling Services, Pllc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3035 Nw 63rd St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Mark Allen Gonzales (OWNER/ THERAPIST) |
| Authorized Official Contact | 4055030490 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Vision Counseling Services, Pllc 3035 Nw 63rd St 230 Oklahoma City OK 73116-3632 Ph: (405) 242-5342 | Life Vision Counseling Services, Pllc 3035 Nw 63rd St 230 Oklahoma City OK 73116-3632 Ph: (405) 242-5342 |
| NPI Number | 1194034983 |
|---|---|
| Provider Enumeration Date | 09/28/2010 |
| Last Update Date | 03/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194034983 | NPI | - | NPPES |
| 200306260A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 2458 (Oklahoma) | Primary |
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