| Corbin Henningsen, Pllc | |
|
849 E 33rd St Edmond OK 73013-5407 | |
| (405) 888-5299 | |
| (405) 888-5322 |
| Full Name | Corbin Henningsen, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 849 E 33rd St, Edmond, Oklahoma |
| Authorized Official Name and Position | Corbin Henningsen (OWNER) |
| Authorized Official Contact | 4058885299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corbin Henningsen, Pllc 849 E 33rd St Edmond OK 73013-5407 Ph: (405) 888-5299 | Corbin Henningsen, Pllc 849 E 33rd St Edmond OK 73013-5407 Ph: (405) 888-5299 |
| NPI Number | 1285273912 |
|---|---|
| Provider Enumeration Date | 12/28/2019 |
| Last Update Date | 02/28/2020 |
| Certification Date | 02/28/2020 |
| Medicare PECOS PAC ID | 1355778754 |
|---|---|
| Medicare Enrollment ID | O20200225000941 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285273912 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Corbin Henningsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558714741 PECOS PAC ID: 7517209273 Enrollment ID: I20190429001224 |
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