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General NPI Number Information
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NPI Number | 1336423086
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Entity Type | Organization
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Legal Business Name | SERENITY BEHAVIORAL SERVICES, PLLC
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 301 N HIGH ST
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City | ANTLERS
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State | OK
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Zip | 74523-2238
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Country | US
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Telephone | 580-271-7055
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Fax | 580-271-7056
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Provider Business Mailing Address
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Address Line | 301 N HIGH ST
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City | ANTLERS
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State | OK
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Zip | 74523-2238
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Country | US
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Telephone | 580-271-7055
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Fax | 580-271-7055
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Authorized Official
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Title or Position | OWNER / CEO
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Name | MRS. MALISA JANE HALLMAN
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Credential | MBS, LBP
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Telephone | 580-271-1638
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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 | 0340
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License Number State | OK
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