| Personal Revolutions Behavioral Health Services, Llc | |
|
6801 S Western Ave Ste 101 Oklahoma City OK 73139-1816 | |
| (405) 550-2688 | |
| (405) 619-3924 |
| Full Name | Personal Revolutions Behavioral Health Services, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6801 S Western Ave Ste 101, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Krystal Dawn Haltom (OWNER) |
| Authorized Official Contact | 4055502688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Personal Revolutions Behavioral Health Services, Llc 6801 S Western Ave Ste 105 Oklahoma City OK 73139-1816 Ph: (405) 550-2688 | Personal Revolutions Behavioral Health Services, Llc 6801 S Western Ave Ste 101 Oklahoma City OK 73139-1816 Ph: (405) 550-2688 |
| NPI Number | 1164939765 |
|---|---|
| Provider Enumeration Date | 01/04/2018 |
| Last Update Date | 03/22/2022 |
| Certification Date | 03/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164939765 | NPI | - | NPPES |
| 2003754400B | Medicaid | OK | |
| 200781380A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6323 (Oklahoma) | Primary |
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