Affect Provider Group, P.S.C.
Counselor, Mental Health in Edmond, OK. Organization (NPI-2).
NPI number1902795255
StatusActive
Last updated in NPPESJul 1, 2025
Details
- NPI
- 1902795255
- Entity type
- Organization (NPI-2)
- Legal business name
- Affect Provider Group, P.S.C.
- Organization subpart
- No
- Enumeration date
- Jul 1, 2025
- Certification date
- Jul 1, 2025
- Last updated
- Jul 1, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
| 103T00000X | Psychologist | – | – | |
| 163WP0809X | Registered Nurse, Psych/Mental Health, Adult | – | – | |
| 103TC0700X | Psychologist, Clinical | – | – | |
| 104100000X | Social Worker | – | – | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | |
| 364SP0808X | Clinical Nurse Specialist, Psych/Mental Health | – | – |
Practice location
3209 S Broadway Ste 229Edmond, OK 73013-4064
Phone 845-769-8758
Mailing address
1640 Boro Pl Fl 4Mc Lean, VA 22102-3627
Phone 845-769-8758
Authorized official
Karla Renee Mullings
Director Of Compliance
8457688758
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