| Life Psychiatric Clinic Pllc | |
|
609 S Kelly Ave Ste B2 Edmond OK 73003-5725 | |
| (405) 724-6871 | |
| (405) 726-0423 |
| Full Name | Life Psychiatric Clinic Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 609 S Kelly Ave Ste B2, Edmond, Oklahoma |
| Authorized Official Name and Position | Mebin Babu Thomas (MEMBER) |
| Authorized Official Contact | 4054149139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Psychiatric Clinic Pllc 609 S Kelly Ave Ste B2 Edmond OK 73003-5725 Ph: (405) 724-6871 | Life Psychiatric Clinic Pllc 609 S Kelly Ave Ste B2 Edmond OK 73003-5725 Ph: (405) 724-6871 |
| NPI Number | 1427722370 |
|---|---|
| Provider Enumeration Date | 08/04/2021 |
| Last Update Date | 04/12/2022 |
| Certification Date | 04/12/2022 |
| Medicare PECOS PAC ID | 7618372764 |
|---|---|
| Medicare Enrollment ID | O20210827000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427722370 | NPI | - | NPPES |
| 201012720A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Rakesh Amin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437445475 PECOS PAC ID: 6002050010 Enrollment ID: I20210827000396 |
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