| Intentional Paths To Recovery, Llc | |
|
1212 S Air Depot Blvd Ste 19b Midwest City OK 73110-4830 | |
| (405) 625-0710 | |
| (405) 796-7328 |
| Full Name | Intentional Paths To Recovery, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1212 S Air Depot Blvd Ste 19b, Midwest City, Oklahoma |
| Authorized Official Name and Position | Tiffany S Harrison (OWNER) |
| Authorized Official Contact | 4056250710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Paths To Recovery, Llc 2000 Eastridge Pl Oklahoma City OK 73141-2226 Ph: (405) 625-0710 | Intentional Paths To Recovery, Llc 1212 S Air Depot Blvd Ste 19b Midwest City OK 73110-4830 Ph: (405) 625-0710 |
| NPI Number | 1124745435 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Medicare PECOS PAC ID | 5496124919 |
|---|---|
| Medicare Enrollment ID | O20221206000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124745435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tiffany Sharrice Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104174556 PECOS PAC ID: 5799154225 Enrollment ID: I20221206000868 |
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