| Self-leadership Center Of Oklahoma | |
|
401 E Memorial Rd Ste 500 Oklahoma City OK 73114-2287 | |
| (405) 924-8651 | |
| Not Available |
| Full Name | Self-leadership Center Of Oklahoma |
|---|---|
| Speciality | Clinic/Center |
| Location | 401 E Memorial Rd Ste 500, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Brandt Ratcliff (OWNER) |
| Authorized Official Contact | 4059248651 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Self-leadership Center Of Oklahoma 3627 Nw 44th St Oklahoma City OK 73112-6169 Ph: (405) 924-8651 | Self-leadership Center Of Oklahoma 401 E Memorial Rd Ste 500 Oklahoma City OK 73114-2287 Ph: (405) 924-8651 |
| NPI Number | 1922888999 |
|---|---|
| Provider Enumeration Date | 10/05/2023 |
| Last Update Date | 10/05/2023 |
| Certification Date | 10/05/2023 |
| Medicare PECOS PAC ID | 1658714357 |
|---|---|
| Medicare Enrollment ID | O20240209001783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922888999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Brandt Ratcliff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629585138 PECOS PAC ID: 2567805260 Enrollment ID: I20240209002111 |
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