| Theo Edwards, | |
|
211 N Highway 59, Kansas, OK 74347-7076 | |
| (918) 786-4434 | |
| Not Available |
| Full Name | Theo Edwards |
|---|---|
| Gender | Male |
| Speciality | Social Worker - Clinical |
| Location | 211 N Highway 59, Kansas, Oklahoma |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194369892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 20136 (Oklahoma) | Primary |
| Entity Name | Grand Lake Mental Health Center, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497762520 PECOS PAC ID: 4688711534 Enrollment ID: O20091026000174 |
| Entity Name | Compass Counseling Services PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1346724747 PECOS PAC ID: 2264764794 Enrollment ID: O20191101000332 |
| Mailing Address | Practice Location Address |
|---|---|
| Theo Edwards, 207 N. Hwy 59, Kansas Ok, Kansas, OK 74347-0000 Ph: (918) 786-4434 | Theo Edwards, 211 N Highway 59, Kansas, OK 74347-7076 Ph: (918) 786-4434 |
Jennifer Ellen Rollman, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 211 N Hwy 11 Unit A & B, Kansas, OK 74347 Phone: 918-786-4434 |
Angela Penn-juenger, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 211 N Highway 59 Ste 2, Kansas, OK 74347 Phone: 405-806-7695 |