=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114570173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRIVE THERAPEUTIC SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2019
-----------------------------------------------------
Last Update Date | 02/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 S 9TH ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73601-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-715-1174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 741
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73601-0741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-715-1174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MS. AMBER HALLABA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-715-1174
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------