MEDICARE: TOTAL CARE BEHAVIORAL HEALTH 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518436518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CARE BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	5350 S WESTERN AVE STE 548
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-4536
Country	:	US
Telephone Number	:	405-471-3601
Fax Number	:	888-875-1829

Provider Business Practice Location Address
First Line	:	5350 S WESTERN AVE STE 548
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-4536
Country	:	US
Telephone Number	:	405-471-3601
Fax Number	:	888-875-1829

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. FELICIA HOLLIS
Credential	:	BA
Telephone Number	:	405-471-3601

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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