| Twenty-nine 11, Inc. | |
|
1605 N Harrison St Shawnee OK 74804-4022 | |
| (405) 765-3789 | |
| Not Available |
| Full Name | Twenty-nine 11, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 1605 N Harrison St, Shawnee, Oklahoma |
| Authorized Official Name and Position | Jill Janae Newman (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4054015215 |
| 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) 401-5215 | Twenty-nine 11, Inc. 1605 N Harrison St Shawnee OK 74804-4022 Ph: (405) 765-3789 |
| NPI Number | 1235680984 |
|---|---|
| Provider Enumeration Date | 10/18/2016 |
| Last Update Date | 10/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235680984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 5641 (Oklahoma) | Primary |
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