1730533860 NPI number — WILD HORSE COUNSELING SERVICE, LLC

Table of content: MS. MOLLY SUE EDWARDS APRN, CNP (NPI 1174257190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730533860 NPI number — WILD HORSE COUNSELING SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILD HORSE COUNSELING SERVICE, 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:
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:
1730533860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
154 W SHADY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATOKA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74525-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-279-9591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 S GIN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATOKA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-279-9591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PADGETT
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
ILENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
580-279-9591

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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