Provider Demographics
NPI:1174392088
Name:ENHANCED LIFE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:ENHANCED LIFE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARNESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-480-9657
Mailing Address - Street 1:632 NW 182ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4582
Mailing Address - Country:US
Mailing Address - Phone:405-480-9657
Mailing Address - Fax:405-888-8727
Practice Address - Street 1:632 NW 182ND ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4582
Practice Address - Country:US
Practice Address - Phone:405-480-9657
Practice Address - Fax:405-888-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty