MEDICARE: MAPLE LIFE SOLUTIONS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740061787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE LIFE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	5013 OAK MANOR DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5013 OAK MANOR DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2235
Country	:	US
Telephone Number	:	405-839-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAMILOLA AKINTOLA
Credential	:
Telephone Number	:	405-839-7600

Provider Enumeration Date	:	10/06/2023
Last Update Date	:	10/06/2023

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Directions to “MAPLE LIFE SOLUTIONS LLC ” Practice Location

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