Oklahoma Mental Health Collective | |
435 W. Main Street Eakly OK 73033 | |
(405) 323-0548 | |
Not Available |
Full Name | Oklahoma Mental Health Collective |
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Speciality | Counselor |
Location | 435 W. Main Street, Eakly, Oklahoma |
Authorized Official Name and Position | Justin Robert Doty (OWNER) |
Authorized Official Contact | 4053230548 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Oklahoma Mental Health Collective Po Box 185 Eakly OK 73033-0185 Ph: (405) 323-0548 | Oklahoma Mental Health Collective 435 W. Main Street Eakly OK 73033 Ph: (405) 323-0548 |
NPI Number | 1033790142 |
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Provider Enumeration Date | 04/20/2021 |
Last Update Date | 11/19/2023 |
Certification Date | 11/19/2023 |
Medicare PECOS PAC ID | 9133562309 |
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Medicare Enrollment ID | O20240205004419 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033790142 | NPI | - | NPPES |
1780694778 | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Rhonda Miachele Harvey |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1780694778 PECOS PAC ID: 1951744127 Enrollment ID: I20240205004431 |
Provider Name | Justin Robert Doty |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1245562529 PECOS PAC ID: 2860835030 Enrollment ID: I20240205004448 |
Provider Name | Marcia Jean Mahurin |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1831565076 PECOS PAC ID: 0143663286 Enrollment ID: I20240206002668 |
Provider Name | Kaylee Young |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1033794110 PECOS PAC ID: 5092158154 Enrollment ID: I20240206003645 |