| Integrated Therapy Solutions Of Oklahoma, Llc | |
|
620 Nw 5th St Ste D Moore OK 73160-3947 | |
| (405) 208-4469 | |
| (405) 208-4472 |
| Full Name | Integrated Therapy Solutions Of Oklahoma, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 620 Nw 5th St Ste D, Moore, Oklahoma |
| Authorized Official Name and Position | Amanda Marie Dupler (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 4052084469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Therapy Solutions Of Oklahoma, Llc 620 Nw 5th St Ste D Moore OK 73160-3947 Ph: (405) 208-4469 | Integrated Therapy Solutions Of Oklahoma, Llc 620 Nw 5th St Ste D Moore OK 73160-3947 Ph: (405) 208-4469 |
| NPI Number | 1659855278 |
|---|---|
| Provider Enumeration Date | 09/19/2018 |
| Last Update Date | 10/18/2022 |
| Certification Date | 10/18/2022 |
| Medicare PECOS PAC ID | 2264808211 |
|---|---|
| Medicare Enrollment ID | O20221018000055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659855278 | NPI | - | NPPES |
| 200850330A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Lacey R Vaughan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902247091 PECOS PAC ID: 4587945332 Enrollment ID: I20170110001573 |
| Provider Name | Raina Don Leckie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497200737 PECOS PAC ID: 7719265990 Enrollment ID: I20180626001927 |
| Provider Name | Ashley M Drees |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346617354 PECOS PAC ID: 0941633812 Enrollment ID: I20191206001099 |
| Provider Name | Honor N Sankey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518345206 PECOS PAC ID: 1557796463 Enrollment ID: I20200123001853 |
| Provider Name | Ellisa Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215401708 PECOS PAC ID: 2365834124 Enrollment ID: I20220128000377 |
| Provider Name | Julie Ann Nolan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962071688 PECOS PAC ID: 9436544087 Enrollment ID: I20220316003892 |
| Provider Name | Marion R Ritchey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427617232 PECOS PAC ID: 5698143964 Enrollment ID: I20221116003218 |
| Provider Name | Trisha M Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669034922 PECOS PAC ID: 6002287786 Enrollment ID: I20230117000019 |
| Provider Name | Kyle Lee Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962851659 PECOS PAC ID: 8426421520 Enrollment ID: I20230309002125 |
| Provider Name | Cailey Breanna Hutson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174028948 PECOS PAC ID: 0345695136 Enrollment ID: I20231013003232 |
| Provider Name | Glenda Cottier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235585894 PECOS PAC ID: 4981059771 Enrollment ID: I20231013003261 |
| Provider Name | Deanna Renee Wilkinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619068541 PECOS PAC ID: 7618322207 Enrollment ID: I20231017003870 |
| Provider Name | Vilman Andre |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1457674707 PECOS PAC ID: 7416301908 Enrollment ID: I20231120001600 |
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