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General NPI Number Information
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NPI Number | 1255927182
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Entity Type | Organization
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Legal Business Name | RESTORATION BEHAVIORAL HEALTH OF MUSKOGEE, LLC
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 315 N 4TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6312
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Country | US
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Telephone | 918-360-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 315 N 4TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6312
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Country | US
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Telephone | 449-185-3720
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHELSEA BROWN
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Credential | M.S., LPC-S
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Telephone | 918-360-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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