Healthcare Provider Details

I. General information

NPI: 1417386509
Provider Name (Legal Business Name): HEARTLAND'S HOPE MENTAL HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N KANSAS AVE STE B
LIBERAL KS
67901-3346
US

IV. Provider business mailing address

PO BOX 132
TURPIN OK
73950-0132
US

V. Phone/Fax

Practice location:
  • Phone: 620-604-5111
  • Fax: 855-687-2518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2478
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2279
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4025
License Number StateOK

VIII. Authorized Official

Name: TERA LYNN ROBINSON
Title or Position: OWNER
Credential: M.A., M.E.D., LPC
Phone: 620-604-5111