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General NPI Number Information
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NPI Number | 1164939765
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Entity Type | Organization
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Legal Business Name | PERSONAL REVOLUTIONS BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 6801 S WESTERN AVE STE 101
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-1816
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Country | US
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Telephone | 405-550-2688
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Fax | 405-619-3924
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Provider Business Mailing Address
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Address Line | 6801 S WESTERN AVE STE 101
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-1816
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Country | US
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Telephone | 405-550-2688
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Fax | 405-619-3924
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL DAWN HALTOM
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Credential | M.A., LPC SUPERVISOR
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Telephone | 405-550-2688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6323
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License Number State | OK
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