| Pennington Creek Life House | |
|
8 S Michigan St Ste B Coalgate OK 74538-2825 | |
| (580) 310-4164 | |
| Not Available |
| Full Name | Pennington Creek Life House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 8 S Michigan St Ste B, Coalgate, Oklahoma |
| Authorized Official Name and Position | Jan M Wyatt (CLINICAL DIRECTOR) |
| Authorized Official Contact | 5803104164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pennington Creek Life House Po Box 261 Fittstown OK 74842-0261 Ph: (580) 310-4164 | Pennington Creek Life House 8 S Michigan St Ste B Coalgate OK 74538-2825 Ph: (580) 310-4164 |
| NPI Number | 1922246115 |
|---|---|
| Provider Enumeration Date | 01/27/2009 |
| Last Update Date | 01/27/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922246115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 3877 (Oklahoma) | Primary |
Jackie Horton Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: Rr 4 Box 854, Coalgate, OK 74538 Phone: 580-399-5398 Fax: 580-927-2346 |