Provider Demographics
NPI:1174711931
Name:PELHAM MAXFIELD, CAROLE DIAN (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:DIAN
Last Name:PELHAM MAXFIELD
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:
Other - Last Name:PELHAM MAXFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC LMFT
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-0762
Mailing Address - Country:US
Mailing Address - Phone:580-786-1221
Mailing Address - Fax:336-850-7028
Practice Address - Street 1:324 S HWY 81
Practice Address - Street 2:RESTORATION COUNSELING AND NEUROFEEDBACK CENTER
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-8320
Practice Address - Country:US
Practice Address - Phone:580-786-1221
Practice Address - Fax:580-531-4519
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLMFT1040106H00000X
OKLPC3807101YM0800X
TXLPC9974101YM0800X
TXLMFT3291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health