| Twenty-nine 11 Inc | |
|
44038 East 45th St Shawnee OK 74804-9683 | |
| (405) 827-2514 | |
| (405) 584-4038 |
| Full Name | Twenty-nine 11 Inc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 44038 East 45th St, Shawnee, Oklahoma |
| Authorized Official Name and Position | Jill J Newman (OWNER) |
| Authorized Official Contact | 4053370055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Twenty-nine 11 Inc 19501 S Rock Creek Rd Shawnee OK 74801-9626 Ph: (405) 760-6638 | Twenty-nine 11 Inc 44038 East 45th St Shawnee OK 74804-9683 Ph: (405) 827-2514 |
| NPI Number | 1184085367 |
|---|---|
| Provider Enumeration Date | 03/15/2016 |
| Last Update Date | 01/21/2022 |
| Certification Date | 01/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184085367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5641 (Oklahoma) | Primary |
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