1679819106 NPI number — ADVANCE COUNSELING, PC

Table of content: (NPI 1679819106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679819106 NPI number — ADVANCE COUNSELING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE COUNSELING, PC
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:
1679819106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1732 REDLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73003-2453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-844-8085
Provider Business Mailing Address Fax Number:
405-285-1652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74074-4056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-844-8085
Provider Business Practice Location Address Fax Number:
405-285-1652
Provider Enumeration Date:
01/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GASTON
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
EDWIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-844-8085

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2578 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200020790H , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com