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General NPI Number Information
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NPI Number | 1124745435
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Entity Type | Organization
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Legal Business Name | INTENTIONAL PATHS TO RECOVERY, LLC
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 5509 MAIN ST STE 103
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City | DEL CITY
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State | OK
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Zip | 73115-5511
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Country | US
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Telephone | 405-627-9308
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 EASTRIDGE PL
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City | OKLAHOMA CITY
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State | OK
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Zip | 73141-2226
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Country | US
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Telephone | 405-625-0710
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Fax | 405-796-7328
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY S HARRISON
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Credential | LCSW, LADC/MH
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Telephone | 405-625-0710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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