MEDICARE: ANOTHER CHANCE COUNSELING AGENCY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	152	OTHER	OK	OKLAHOMA DEPT. OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

General Provider Information

NPI Number	:	1225316003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER CHANCE COUNSELING AGENCY, INC

Provider Business Mailing Address
First Line	:	8306 NE 10TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7155
Country	:	US
Telephone Number	:	405-732-0573
Fax Number	:	405-455-3989

Provider Business Practice Location Address
First Line	:	8306 NE 10TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7155
Country	:	US
Telephone Number	:	405-732-0573
Fax Number	:	405-455-3989

Authorized Official
Title or Position	:	COO
Name	:	MRS. FELICIA ANN MANNING
Credential	:
Telephone Number	:	405-732-0573

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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