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General NPI Number Information
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NPI Number | 1972155695
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Entity Type | Organization
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Legal Business Name | SERENITY OUTPATIENT SERVICES, PLLC
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 3013 N HIGHWAY 167 STE B
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City | CATOOSA
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State | OK
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Zip | 74015-3348
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Country | US
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Telephone | 918-640-9002
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Fax | 918-739-3068
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Provider Business Mailing Address
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Address Line | 3013 N HIGHWAY 167 STE B
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City | CATOOSA
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State | OK
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Zip | 74015-3348
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Country | US
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Telephone | 918-640-9002
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | BETTY HULL
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Credential | LPC
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Telephone | 918-640-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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