| The Ivy Center, LLC | |
|
15980 Trailhead Rd Mcloud OK 74851-5015 | |
| (405) 827-4666 | |
| (405) 383-4756 |
| Full Name | The Ivy Center, LLC |
|---|---|
| Speciality | Community/Behavioral Health |
| 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 | 02/18/2026 |
| Certification Date | 02/18/2026 |
| Medicare PECOS PAC ID | 2961934518 |
|---|---|
| Medicare Enrollment ID | O20241021002059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205672797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (NU) | Primary |
| Provider Name | Juanita Pearl Marshall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992260004 PECOS PAC ID: 4082054572 Enrollment ID: I20240501001568 |
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