MEDICARE: THE POSSIBILITIES PLACE 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497368179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE POSSIBILITIES PLACE LLC

Provider Business Mailing Address
First Line	:	6900 BASSWOOD CANYON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-7207
Country	:	US
Telephone Number	:	405-922-9055
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 BASSWOOD CANYON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-7207
Country	:	US
Telephone Number	:	405-922-9055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA KANARY
Credential	:	LPC
Telephone Number	:	405-922-9055

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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