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12617 S Mcloud Rd Mcloud OK 74851-8509 | |
| (405) 986-0173 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 12617 S Mcloud Rd, Mcloud, Oklahoma |
| Authorized Official Name and Position | Jennifer Gayle Allen (OWNER) |
| Authorized Official Contact | 4059860173 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
339757 E 890 Rd Chandler OK 74834-7066 Ph: (405) 986-0173 | 12617 S Mcloud Rd Mcloud OK 74851-8509 Ph: (405) 986-0173 |
| NPI Number | 1730963539 |
|---|---|
| Provider Enumeration Date | 08/22/2023 |
| Last Update Date | 01/08/2025 |
| Certification Date | 01/08/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730963539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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