=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881952935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENERATE BEHAVIORAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2012
-----------------------------------------------------
Last Update Date | 04/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2944 NW 156TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-513-7794
-----------------------------------------------------
Fax | 405-513-7796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2944 NW 156TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-513-7794
-----------------------------------------------------
Fax | 405-513-7796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. LIVINUS CHIDI ONWUCHURUBA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-826-0370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------