Provider Demographics
NPI:1861738148
Name:EVANESCENCE COUNSELING PLLC
Entity type:Organization
Organization Name:EVANESCENCE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DANKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-420-7877
Mailing Address - Street 1:5909 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 238
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5161
Mailing Address - Country:US
Mailing Address - Phone:405-420-7877
Mailing Address - Fax:
Practice Address - Street 1:5909 NW EXPRESSWAY
Practice Address - Street 2:SUITE 238
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5161
Practice Address - Country:US
Practice Address - Phone:405-420-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4643101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200372680BMedicaid