1275853301 NPI number — COMMUNITY LEARNING COUNCIL, INC.

Table of content: TREVOR D. NELSON M.D. (NPI 1366494577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275853301 NPI number — COMMUNITY LEARNING COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY LEARNING COUNCIL, INC.
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:
1275853301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20414
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73156-0414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 NW EXPRESSWAY
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-7227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-751-4219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DECOTEAU
Authorized Official First Name:
GINGER
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER, EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
405-751-4219

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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