Pennington Creek Life House

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

3877 Issued in OK

Legal business name

PENNINGTON CREEK LIFE HOUSE

Practice address

8 S Michigan St Ste B
Coalgate, OK 74538-2825

Phone

(580) 310-4164

NPI assigned

Jan 27, 2009

Last updated

Jan 27, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jan M Wyatt, MS LPC

Title

Clinical Director

Phone

(580) 310-4164

Specialties & licenses 1

Addresses

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.

• Pennington Creek Lifehouse

  • Community/Behavioral Health Agency
  • Tishomingo, OK
  • NPI 1831464304
  NPD tax ID

Locations

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233014400000",
    "number": "1922246115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 261",
            "city": "FITTSTOWN",
            "state": "OK",
            "postal_code": "748420261",
            "telephone_number": "580-310-4164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 S MICHIGAN ST STE B",
            "city": "COALGATE",
            "state": "OK",
            "postal_code": "745382825",
            "telephone_number": "580-310-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNINGTON CREEK LIFE HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-27",
        "last_updated": "2009-01-27",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "580-310-4164",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OK",
            "license": "3877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palace Drug of Coalgate LLC (Palace Drug)
• Kenda Pebworth
• Penney Rehab and Wellness Center, LLC
• Stephen John Penney, P.T.
• Tracy Mowdy Penney, M.S. CCC-SLP
• Richard J Helton (Helton Rural Health Clinic)
• Richard J Helton
• Madisyn Romano
• Jamie Niccole Smith
• Alyssia Leann Tomlinson, BS

• Community/Behavioral Health Agency in Coalgate, OK
• Providers in Coalgate, OK by specialty
• Community/Behavioral Health Agency in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.