MEDICARE: EBP & ME, 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	251S00000X	Community/Behavioral Health Agency	C010058	NC

General Provider Information

NPI Number	:	1417310186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBP & ME, LLC

Provider Business Mailing Address
First Line	:	5116 SW 126TH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-8821
Country	:	US
Telephone Number	:	405-343-1585
Fax Number	:

Provider Business Practice Location Address
First Line	:	5116 SW 126TH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-8821
Country	:	US
Telephone Number	:	405-343-1585
Fax Number	:

Authorized Official
Title or Position	:	SOLE LLC AGENT
Name	:	MR. CRAIG ALAN CARPENTER
Credential	:	LCSW
Telephone Number	:	405-343-1585

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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