Provider Demographics
NPI:1295517498
Name:PATRICIA L. REMBERT-ANDERSON, LPC, COUNSELING, P.L.L.C.
Entity type:Organization
Organization Name:PATRICIA L. REMBERT-ANDERSON, LPC, COUNSELING, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REMBERT-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LPC, NCC
Authorized Official - Phone:580-341-7177
Mailing Address - Street 1:1704 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3625
Mailing Address - Country:US
Mailing Address - Phone:580-595-7114
Mailing Address - Fax:
Practice Address - Street 1:1704 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3625
Practice Address - Country:US
Practice Address - Phone:580-595-7114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200838300AMedicaid