| Heart For Change, Llc | |
|
318 N Broadway Ave Shawnee OK 74801-6920 | |
| (405) 513-1862 | |
| Not Available |
| Full Name | Heart For Change, Llc |
|---|---|
| Speciality | Counselor |
| Location | 318 N Broadway Ave, Shawnee, Oklahoma |
| Authorized Official Name and Position | Alyse Walker (OWNER) |
| Authorized Official Contact | 4055131862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart For Change, Llc 318 N Broadway Ave Shawnee OK 74801-6920 Ph: (405) 513-1862 | Heart For Change, Llc 318 N Broadway Ave Shawnee OK 74801-6920 Ph: (405) 513-1862 |
| NPI Number | 1437745551 |
|---|---|
| Provider Enumeration Date | 12/13/2020 |
| Last Update Date | 12/13/2020 |
| Certification Date | 12/13/2020 |
| Medicare PECOS PAC ID | 2062881634 |
|---|---|
| Medicare Enrollment ID | O20221205000765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437745551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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