MEDICARE: MENTAL HEALTH RECOVERY

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	305S00000X	Point of Service	082760801	OK

General Provider Information

NPI Number	:	1588984553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH RECOVERY

Provider Business Mailing Address
First Line	:	2201 NW 122ND ST APT 513
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 NW 122ND ST APT 513
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8405
Country	:	US
Telephone Number	:	405-605-0398
Fax Number	:

Authorized Official
Title or Position	:	REHAB SPECIALIST
Name	:	EBONY JOY JONES
Credential	:
Telephone Number	:	405-605-0398

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	04/28/2012

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Directions to “MENTAL HEALTH RECOVERY ” Practice Location

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