MEDICARE: PUZZLE PEACE COUNSELING, 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	1041C0700X	Clinical Social Worker	4276	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	:	1851813257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUZZLE PEACE COUNSELING, INC

Provider Business Mailing Address
First Line	:	7108 NW 145TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-7854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 E 19TH ST STE 190
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6566
Country	:	US
Telephone Number	:	405-568-1950
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA GROSSENBACHER
Credential	:	LCSW
Telephone Number	:	405-568-1950

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/07/2017

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Directions to “PUZZLE PEACE COUNSELING, INC ” Practice Location

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