MEDICARE: NDN CONSULTING SERVICES, LLC

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	:	1457642621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NDN CONSULTING SERVICES, LLC

Provider Business Mailing Address
First Line	:	5272 S LEWIS AVE
Second Line	:	SUITE 220
City	:	TULSA
State	:	OK
Zip	:	74105-6544
Country	:	US
Telephone Number	:	918-712-8882
Fax Number	:	888-420-6673

Provider Business Practice Location Address
First Line	:	5272 S LEWIS AVE
Second Line	:	SUITE 220
City	:	TULSA
State	:	OK
Zip	:	74105-6544
Country	:	US
Telephone Number	:	918-712-8882
Fax Number	:	888-420-6673

Authorized Official
Title or Position	:	CEO
Name	:	MS. MAJICK RAVENHAWK
Credential	:	CHHP, PH.D
Telephone Number	:	918-712-8882

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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