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General NPI Number Information
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NPI Number | 1083126957
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Entity Type | Organization
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Legal Business Name | SERENITY THERAPY PC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 531 E A ST STE 101B
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City | JENKS
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State | OK
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Zip | 74037-4117
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Country | US
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Telephone | 918-973-0054
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Fax | 918-528-3506
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Provider Business Mailing Address
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Address Line | 531 E A ST STE 101B
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City | JENKS
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State | OK
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Zip | 74037-4117
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Country | US
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Telephone | 918-973-0054
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Fax | 918-528-3506
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | HAILEY CHAPPELL
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Credential | LPC
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Telephone | 918-973-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6367
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License Number State | OK
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