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General NPI Number Information
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NPI Number | 1144073040
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Entity Type | Organization
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Legal Business Name | IDYLL BEHAVIORAL HEALTH SOLUTIONS
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 15004 SALEM CREEK RD
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City | EDMOND
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State | OK
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Zip | 73013-2454
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Country | US
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Telephone | 832-848-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 15004 SALEM CREEK RD
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City | EDMOND
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State | OK
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Zip | 73013-2454
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Country | US
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Telephone | 682-521-5224
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | EBELECHUKWU EKWENUGO
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Credential | NP
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Telephone | 832-848-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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