1285142992 NPI number — GENERATIONS PSYCHOLOGY AND COUNSELING, LLC

Table of content: (NPI 1285142992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285142992 NPI number — GENERATIONS PSYCHOLOGY AND COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERATIONS PSYCHOLOGY AND COUNSELING, LLC
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:
SHANTEL MITCHELL-COOLEY, LCSW
Provider Other Organization Name Type Code:
3
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:
1285142992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 720954
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:
73172-0954
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:
5912 W HEFNER RD STE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73162-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-659-2403
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL-COOLEY
Authorized Official First Name:
SHANTEL
Authorized Official Middle Name:
Authorized Official Title or Position:
LCSW
Authorized Official Telephone Number:
405-659-2403

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1290 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 5827 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1290 . This is a "LICENSED PSYCHOLOGIST" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 5827 . This is a "CLINICAL SOCIAL WORKER LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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