| Beauty For Ashes, Llc | |
|
849 E 33rd St Edmond OK 73013-5407 | |
| (405) 367-9034 | |
| (405) 751-2223 |
| Full Name | Beauty For Ashes, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 849 E 33rd St, Edmond, Oklahoma |
| Authorized Official Name and Position | Portia Goldsmith-nickelberry (OWNER/OPERATOR) |
| Authorized Official Contact | 4053679034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beauty For Ashes, Llc 849 E 33rd St Edmond OK 73013-5407 Ph: (405) 367-9034 | Beauty For Ashes, Llc 849 E 33rd St Edmond OK 73013-5407 Ph: (405) 367-9034 |
| NPI Number | 1134510795 |
|---|---|
| Provider Enumeration Date | 02/17/2015 |
| Last Update Date | 09/25/2025 |
| Certification Date | 09/25/2025 |
| Medicare PECOS PAC ID | 3971892282 |
|---|---|
| Medicare Enrollment ID | O20160510000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134510795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 4889 (Oklahoma) | Primary |
| Provider Name | Portia Goldsmith Nickelberry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730490079 PECOS PAC ID: 4880983196 Enrollment ID: I20160510000647 |
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