| Reliance Mental Health And Functional Medicine | |
|
7415 Nw 23rd St Bethany OK 73008-5135 | |
| (405) 999-9999 | |
| Not Available |
| Full Name | Reliance Mental Health And Functional Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 7415 Nw 23rd St, Bethany, Oklahoma |
| Authorized Official Name and Position | Nicoline Lami Edie (OWNER) |
| Authorized Official Contact | 4055018806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reliance Mental Health And Functional Medicine 7415 Nw 23rd St Bethany OK 73008-5135 Ph: (405) 501-8806 | Reliance Mental Health And Functional Medicine 7415 Nw 23rd St Bethany OK 73008-5135 Ph: (405) 999-9999 |
| NPI Number | 1124705348 |
|---|---|
| Provider Enumeration Date | 06/29/2023 |
| Last Update Date | 03/19/2024 |
| Medicare PECOS PAC ID | 9739527318 |
|---|---|
| Medicare Enrollment ID | O20240402000791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124705348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Secondary |
| Provider Name | Nicoline Lami Edie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992274724 PECOS PAC ID: 3476900184 Enrollment ID: I20231116002561 |
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