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General NPI Number Information
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NPI Number | 1801359989
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Entity Type | Organization
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Legal Business Name | TAKE HEART THERAPY, LLC
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Dates
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Enumeration Date | 04/07/2019
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Last Update Date | 04/07/2019
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Provider Practice Location Address
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Address Line | 519 E 141ST ST STE L
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City | GLENPOOL
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State | OK
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Zip | 74033-3588
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Country | US
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Telephone | 918-641-4605
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 HARRELD RD
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City | BEGGS
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State | OK
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Zip | 74421-2478
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Country | US
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Telephone | 918-857-5244
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/MENTAL HEALTH
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Name | KAITLIN ROUK
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Credential | LPC
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Telephone | 918-857-5244
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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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