MEDICARE: HEARTLAND'S HOPE MENTAL HEALTH CENTER, 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	235Z00000X	Speech-Language Pathologist	2279	KS
2	235Z00000X	Speech-Language Pathologist	4025	OK
3	101YP2500X	Professional Counselor	2478	KS

General Provider Information

NPI Number	:	1417386509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND'S HOPE MENTAL HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 132
Second Line	:
City	:	TURPIN
State	:	OK
Zip	:	73950-0132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 N KANSAS AVE STE B
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-3346
Country	:	US
Telephone Number	:	620-604-5111
Fax Number	:	855-687-2518

Authorized Official
Title or Position	:	OWNER
Name	:	TERA LYNN ROBINSON
Credential	:	M.A., M.E.D., LPC
Telephone Number	:	620-604-5111

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	09/24/2018

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Directions to “HEARTLAND'S HOPE MENTAL HEALTH CENTER, LLC ” Practice Location

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