| Our House Mhsa Inc | |
|
2305 Sw H Ave Lawton OK 73505-8103 | |
| (580) 699-8000 | |
| (580) 699-2437 |
| Full Name | Our House Mhsa Inc |
|---|---|
| Speciality | Counselor |
| Location | 2305 Sw H Ave, Lawton, Oklahoma |
| Authorized Official Name and Position | Dewell Brewer (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5806998000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Our House Mhsa Inc 2305 Sw H Ave Ste 1 Lawton OK 73505-8103 Ph: (580) 699-8000 | Our House Mhsa Inc 2305 Sw H Ave Lawton OK 73505-8103 Ph: (580) 699-8000 |
| NPI Number | 1790144160 |
|---|---|
| Provider Enumeration Date | 02/15/2016 |
| Last Update Date | 12/29/2023 |
| Certification Date | 12/28/2023 |
| Medicare PECOS PAC ID | 8628428455 |
|---|---|
| Medicare Enrollment ID | O20240513003509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790144160 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Deshawn Brewer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386914885 PECOS PAC ID: 2961843602 Enrollment ID: I20240513003587 |
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