| Consulting And Counseling For Community Change, Pllc | |
|
2021 Mahaney Ave Ste 4 Tahlequah OK 74464-5795 | |
| (918) 901-9300 | |
| (918) 901-9339 |
| Full Name | Consulting And Counseling For Community Change, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2021 Mahaney Ave Ste 4, Tahlequah, Oklahoma |
| Authorized Official Name and Position | Levi Taylor Keehler (OWNER) |
| Authorized Official Contact | 9189019300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Consulting And Counseling For Community Change, Pllc 1313 Cathy Ave Tahlequah OK 74464-6609 Ph: (918) 772-8466 | Consulting And Counseling For Community Change, Pllc 2021 Mahaney Ave Ste 4 Tahlequah OK 74464-5795 Ph: (918) 901-9300 |
| NPI Number | 1922483627 |
|---|---|
| Provider Enumeration Date | 07/22/2015 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Medicare PECOS PAC ID | 1456897123 |
|---|---|
| Medicare Enrollment ID | O20240718003094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922483627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 3992 (Oklahoma) | Primary |
| 251S00000X | Community/behavioral Health | 606 (Oklahoma) | Secondary |
| Provider Name | Sherry A Chennault |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033472303 PECOS PAC ID: 4284179920 Enrollment ID: I20240717002607 |
| Provider Name | Levi Taylor Keehler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386801942 PECOS PAC ID: 4183160856 Enrollment ID: I20240718003474 |
| Provider Name | Melissa Pitts Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710376421 PECOS PAC ID: 9638619273 Enrollment ID: I20240910000844 |
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