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General NPI Number Information
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NPI Number | 1043926660
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Entity Type | Organization
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Legal Business Name | HERITAGE THERAPEUTIC INC
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 3600 W MAIN ST STE 150
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City | NORMAN
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State | OK
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Zip | 73072-4648
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Country | US
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Telephone | 405-638-8128
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 W MAIN ST STE 150
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City | NORMAN
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State | OK
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Zip | 73072-4648
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | CHRISTIANA AGGREH
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Credential |
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Telephone | 405-638-8128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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