| The Ivy Center, Llc | |
|
15980 Trailhead Rd Mcloud OK 74851-5015 | |
| (405) 827-4666 | |
| (405) 383-4756 |
| Full Name | The Ivy Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 15980 Trailhead Rd, Mcloud, Oklahoma |
| Authorized Official Name and Position | Juantia Marshall (OWNER) |
| Authorized Official Contact | 4058274666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Ivy Center, Llc 15980 Trailhead Rd Mcloud OK 74851-5015 Ph: (405) 827-4666 | The Ivy Center, Llc 15980 Trailhead Rd Mcloud OK 74851-5015 Ph: (405) 827-4666 |
| NPI Number | 1205672797 |
|---|---|
| Provider Enumeration Date | 07/03/2024 |
| Last Update Date | 07/03/2024 |
| Certification Date | 07/03/2024 |
| Medicare PECOS PAC ID | 2961934518 |
|---|---|
| Medicare Enrollment ID | O20241021002059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205672797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Juanita Pearl Marshall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992260004 PECOS PAC ID: 4082054572 Enrollment ID: I20240501001568 |
Kickapoo Tribal Health Center Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 105365 S. Hwy 102, Building M, Mcloud, OK 74851 Phone: 405-964-2081 Fax: 405-964-2053 | |
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Jennifer Allen Therapy And Consultation Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 12617 S Mcloud Rd, Mcloud, OK 74851 Phone: 405-986-0173 | |
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