Healthcare Provider Details

I. General information

NPI: 1659662161
Provider Name (Legal Business Name): TRANSCENDENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E CANADIAN AVE
VINITA OK
74301-3713
US

IV. Provider business mailing address

28686 S 4340 RD
VINITA OK
74301-7708
US

V. Phone/Fax

Practice location:
  • Phone: 918-915-0084
  • Fax:
Mailing address:
  • Phone: 918-915-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number12186
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number649
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4354
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4773
License Number StateOK

VIII. Authorized Official

Name: SHERRY L MILLER
Title or Position: OWNER/CEO
Credential: M.S., LPC, LADC
Phone: 918-915-0084