Healthcare Provider Details

I. General information

NPI: 1235800939
Provider Name (Legal Business Name): DISCOVERING HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15210 S 4060 RD LOT B
OOLOGAH OK
74053-3735
US

IV. Provider business mailing address

15210 S 4060 RD LOT B
OOLOGAH OK
74053-3735
US

V. Phone/Fax

Practice location:
  • Phone: 918-230-9580
  • Fax:
Mailing address:
  • Phone: 918-230-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLI M ELLIS
Title or Position: OWNER/CEO
Credential: LPC
Phone: 918-230-9580