NPIMap

Organization Active NPI

Pennington Creek Lifehouse

  • Community/Behavioral Health Agency
  • Tishomingo, OK
National Provider Identifier
1831464304
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PENNINGTON CREEK LIFEHOUSE
Practice address
801 E Main St
Tishomingo, OK 73460-2351
Phone
(580) 371-3799
Fax
(580) 371-2056
NPI assigned
Mar 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jan Owens, LPC
Title
Owner
Phone
(580) 371-3799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

801 E Main St
Tishomingo, OK 73460-2351

Mailing address

801 E Main St
Tishomingo, OK 73460-2351
Phone (580) 371-3799

National Provider Directory

National Provider Directory
Tax ID family
Pennington Creek Life House2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1831464304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734602351",
            "telephone_number": "580-371-3799",
            "fax_number": "580-371-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734602351",
            "telephone_number": "580-371-3799",
            "fax_number": "580-371-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNINGTON CREEK LIFEHOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-371-3799",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.