MEDICARE: DO NO HARM THERAPEUTIC GROUP, 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	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	5449	OK
3	1041C0700X	Clinical Social Worker	5801	OK
4	1041C0700X	Clinical Social Worker	4561	OK
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1942703558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DO NO HARM THERAPEUTIC GROUP, LLC

Provider Business Mailing Address
First Line	:	13928 S 300TH EAST AVE
Second Line	:
City	:	COWETA
State	:	OK
Zip	:	74429-7825
Country	:	US
Telephone Number	:	918-557-9141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 S HARVARD AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6126
Country	:	US
Telephone Number	:	918-557-9141
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/THERAPIST
Name	:	ALLISON MASON
Credential	:	LCSW
Telephone Number	:	918-557-9141

Provider Enumeration Date	:	03/10/2018
Last Update Date	:	03/10/2018

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