Healthcare Provider Details

I. General information

NPI: 1518333087
Provider Name (Legal Business Name): PEACEFUL FAMILY SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 S DOUGLAS AVE
OKLAHOMA CITY OK
73139-1911
US

IV. Provider business mailing address

7405 S. DOUGLAS AVENUE
OKLAHOMA CITY OK
73139
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-2691
  • Fax: 405-601-2773
Mailing address:
  • Phone: 405-601-2691
  • Fax: 405-601-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number922
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number922
License Number StateOK

VIII. Authorized Official

Name: FORREST BRENT KATIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LADC/MH
Phone: 405-601-2691