| Distinctive Adolescent And Adult Guidance Counseling Services | |
|
2119 Riverwalk Dr # 218 Moore OK 73160-2700 | |
| (405) 812-8623 | |
| Not Available |
| Full Name | Distinctive Adolescent And Adult Guidance Counseling Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2119 Riverwalk Dr # 218, Moore, Oklahoma |
| Authorized Official Name and Position | Deborah A Gray (OWNER) |
| Authorized Official Contact | 4058128623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Distinctive Adolescent And Adult Guidance Counseling Services 2119 Riverwalk Dr # 218 Moore OK 73160-2700 Ph: (405) 812-8623 | Distinctive Adolescent And Adult Guidance Counseling Services 2119 Riverwalk Dr # 218 Moore OK 73160-2700 Ph: (405) 812-8623 |
| NPI Number | 1740517366 |
|---|---|
| Provider Enumeration Date | 11/04/2009 |
| Last Update Date | 11/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740517366 | NPI | - | NPPES |
| 100735950 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4096 (Oklahoma) | Primary |
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