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General NPI Number Information
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NPI Number | 1780332635
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Entity Type | Organization
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Legal Business Name | AT PEACE MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 7804 E 108TH ST STE C
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City | TULSA
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State | OK
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Zip | 74133-7423
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Country | US
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Telephone | 918-381-5292
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Fax | 918-984-9497
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Provider Business Mailing Address
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Address Line | 1608 E GRANGER ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-8311
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Country | US
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Telephone | 918-381-5292
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Fax | 918-984-9497
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Authorized Official
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Title or Position | OWNER
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Name | JACLYN KAY JOHNDROW
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Credential | LPC S
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Telephone | 918-381-5292
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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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