=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164960977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY IN SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2017
-----------------------------------------------------
Last Update Date | 02/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 N MAIN ST
-----------------------------------------------------
City | KINGFISHER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73750-2739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-538-6407
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1327 S 8TH ST
-----------------------------------------------------
City | KINGFISHER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73750-4205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-538-6407
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST/OWNER
-----------------------------------------------------
Name | ELIZABETH A HEMME
-----------------------------------------------------
Credential | L.A.D.C.-M.H.
-----------------------------------------------------
Telephone | 405-538-6407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 1199
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1199
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1199
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1199
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------