=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851768196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCEPT HAPPINESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2015
-----------------------------------------------------
Last Update Date | 08/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 928 N YORK ST STE 14
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74403-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-577-5039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1944 E MOFFETT LN
-----------------------------------------------------
City | FORT GIBSON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74434-7607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-577-5039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAMMY WARREN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 918-577-5039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4253
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------