1124302302 NPI number — NUTRITION COUNSELING CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124302302 NPI number — NUTRITION COUNSELING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUTRITION COUNSELING CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124302302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N STONEWALL AVE
Provider Second Line Business Mailing Address:
AHB 3057
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73117-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-2113
Provider Business Mailing Address Fax Number:
405-271-1560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N STONEWALL AVE
Provider Second Line Business Practice Location Address:
AHB 1082
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73117-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-2866
Provider Business Practice Location Address Fax Number:
405-271-3360
Provider Enumeration Date:
10/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
PATSY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATIVE COORDINATOR
Authorized Official Telephone Number:
405-271-2113

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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