MEDICARE: TACTICAL WELLNESS SERVICES, PLLC

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	:	1528904240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TACTICAL WELLNESS SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1401 NW 150TH ST STE A
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2169
Country	:	US
Telephone Number	:	405-829-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 NW 150TH ST STE A
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2169
Country	:	US
Telephone Number	:	405-829-3606
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HANAH PLOUB
Credential	:	MS, LPC-S
Telephone Number	:	405-829-3606

Provider Enumeration Date	:	04/25/2026
Last Update Date	:	04/25/2026

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