MEDICARE: ADVANCED THERAPY ASSOCIATES, 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

General Provider Information

NPI Number	:	1558506857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED THERAPY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	9212 N KELLEY AVE
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-2419
Country	:	US
Telephone Number	:	405-242-5070
Fax Number	:	405-242-5071

Provider Business Practice Location Address
First Line	:	9212 N KELLEY AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-2419
Country	:	US
Telephone Number	:	405-242-5070
Fax Number	:	405-242-5071

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ELISABETH PESCE
Credential	:
Telephone Number	:	904-605-4986

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2022

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