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General NPI Number Information
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NPI Number | 1518585595
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Entity Type | Organization
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Legal Business Name | TWELFTH HOUSE WELLNESS LLC
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 616 NW 21ST ST STE 107
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-1861
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Country | US
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Telephone | 405-999-7525
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Fax |
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Provider Business Mailing Address
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Address Line | 616 NW 21ST ST STE 107
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-1861
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Country | US
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Telephone | 405-999-7525
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | SARAH PAIGE WHITEWATER
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Credential | OK LPC #7013
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Telephone | 405-999-7525
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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 |
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License Number State |
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