MEDICARE: PEACEFUL FAMILY SOLUTIONS 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	101YM0800X	Mental Health Counselor	922	OK
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	922	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518333087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL FAMILY SOLUTIONS INC

Provider Business Mailing Address
First Line	:	7405 S. DOUGLAS AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139
Country	:	US
Telephone Number	:	405-601-2691
Fax Number	:	405-601-2773

Provider Business Practice Location Address
First Line	:	7405 S DOUGLAS AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1911
Country	:	US
Telephone Number	:	405-601-2691
Fax Number	:	405-601-2773

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	FORREST BRENT KATIGAN
Credential	:	LADC/MH
Telephone Number	:	405-601-2691

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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