| New Life Counseling Alliance | |
|
603 W Gary Blvd Clinton OK 73601-2715 | |
| (580) 500-8050 | |
| (888) 344-9087 |
| Full Name | New Life Counseling Alliance |
|---|---|
| Speciality | Social Worker |
| Location | 603 W Gary Blvd, Clinton, Oklahoma |
| Authorized Official Name and Position | Richard S Waguespack (OWNER / PROVIDER) |
| Authorized Official Contact | 5805008050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Life Counseling Alliance 303 N Market St Cordell OK 73632-4229 Ph: (580) 500-8050 | New Life Counseling Alliance 603 W Gary Blvd Clinton OK 73601-2715 Ph: (580) 500-8050 |
| NPI Number | 1568176741 |
|---|---|
| Provider Enumeration Date | 01/11/2023 |
| Last Update Date | 01/11/2023 |
| Certification Date | 01/11/2023 |
| Medicare PECOS PAC ID | 4981077815 |
|---|---|
| Medicare Enrollment ID | O20230223002824 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568176741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Richard S Waguespack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922361393 PECOS PAC ID: 8426291147 Enrollment ID: I20130828000790 |
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