MEDICARE: SOARING HEIGHTS MENTAL HEALTH, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255162665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOARING HEIGHTS MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1300 SUMMERS PL
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-4443
Country	:	US
Telephone Number	:	406-998-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 SUMMERS PL
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-4443
Country	:	US
Telephone Number	:	406-998-8390
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE OLMSTEAD
Credential	:	LCSW
Telephone Number	:	406-998-8390

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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