MEDICARE: BEHAVIORAL WELLNESS AND CARE TEAM OF OK 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811748601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL WELLNESS AND CARE TEAM OF OK LLC

Provider Business Mailing Address
First Line	:	2000 EASTRIDGE PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-2226
Country	:	US
Telephone Number	:	405-627-9308
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 MAIN ST STE 102
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5511
Country	:	US
Telephone Number	:	405-627-9308
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY S HARRISON
Credential	:	LCSW LADC/MH
Telephone Number	:	405-627-9308

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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