Mrs Allie Grantham, MHR, LPC, CADC | |
529 N Oak Ave, Tahlequah, OK 74464 | |
(918) 444-2126 | |
(918) 458-2300 |
Full Name | Mrs Allie Grantham |
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Gender | Female |
Speciality | Counselor |
Location | 529 N Oak Ave, Tahlequah, Oklahoma |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1447388178 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
101Y00000X | Counselor | 6374 (Oklahoma) | Primary |
Entity Name | Northeastern Oklahoma Community Health Centers, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1518070481 PECOS PAC ID: 3678482635 Enrollment ID: O20031104000417 |
Mailing Address | Practice Location Address |
---|---|
Mrs Allie Grantham, MHR, LPC, CADC 31824 E 720 Rd, Wagoner, OK 74467-7374 Ph: (918) 485-9661 | Mrs Allie Grantham, MHR, LPC, CADC 529 N Oak Ave, Tahlequah, OK 74464 Ph: (918) 444-2126 |
Alicia Franke, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1606 E Downing St, Tahlequah, OK 74464 Phone: 918-775-7787 | |
Mr. Chad Alvin Harp, MS ED. Counselor Medicare: Not Enrolled in Medicare Practice Location: 505 Talley St, Tahlequah, OK 74464 Phone: 918-728-1685 | |
Matthew Dennis Wenske, LPC-CANDIDATE Counselor Medicare: Not Enrolled in Medicare Practice Location: 1640 W Keetoowah St, Tahlequah, OK 74464 Phone: 918-708-9009 Fax: 918-708-1714 | |
Sara Howell, Counselor Medicare: Not Enrolled in Medicare Practice Location: 711 S Muskogee Ave, Tahlequah, OK 74464 Phone: 918-207-0078 | |
Terrah Lynn Manes, LCSW Counselor Medicare: Medicare Enrolled Practice Location: 711 S Muskogee Ave, Tahlequah, OK 74464 Phone: 918-207-0078 Fax: 918-207-0558 | |
Ms. Rhonda Carey, BHRS Counselor Medicare: Not Enrolled in Medicare Practice Location: 321 W Shawnee St, Tahlequah, OK 74464 Phone: 918-207-7523 | |
Corey A Thornton, MSW Counselor Medicare: Medicare Enrolled Practice Location: 711 S Muskogee Ave, Tahlequah, OK 74464 Phone: 918-207-0078 |