MEDICARE: U2EXCEL-N-LIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376291286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U2EXCEL-N-LIFE

Provider Business Mailing Address
First Line	:	11916 SILVERMOON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1094
Country	:	US
Telephone Number	:	405-637-6343
Fax Number	:

Provider Business Practice Location Address
First Line	:	11901 N MACARTHUR BLVD STE C7
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1852
Country	:	US
Telephone Number	:	405-637-6343
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DELORES PARKER
Credential	:	MS, LPC, RPT
Telephone Number	:	405-637-6343

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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