Healthcare Provider Details

I. General information

NPI: 1801160841
Provider Name (Legal Business Name): INNER PEACE PASTORAL COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N LEE AVE SUITE 101
OKLAHOMA CITY OK
73103-2600
US

IV. Provider business mailing address

1111 N LEE AVE SUITE 101
OKLAHOMA CITY OK
73103-2600
US

V. Phone/Fax

Practice location:
  • Phone: 405-820-6992
  • Fax: 405-606-7449
Mailing address:
  • Phone: 405-820-6992
  • Fax: 405-606-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number3102
License Number StateOK

VIII. Authorized Official

Name: DR. MARK D. HEANEY
Title or Position: OWNER
Credential: LPC
Phone: 405-820-6992