Pennington Creek Lifehouse

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

PENNINGTON CREEK LIFEHOUSE

Practice address

705 W Main St
Tishomingo, OK 73460-1734

Phone

(580) 371-3799

Fax

(580) 371-2056

NPI assigned

Jul 4, 2011

Organization subpart

No

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

Authorized official

Name

Jan M Owens, M.S. LPC

Title

Owner/ Therapist

Phone

(580) 371-3799

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1309737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309737600000",
    "number": "1962799593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 W MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601734",
            "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": "705 W MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601734",
            "telephone_number": "580-371-3799",
            "fax_number": "580-371-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNINGTON CREEK LIFEHOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-04",
        "last_updated": "2011-07-04",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/ THERAPIST",
        "authorized_official_telephone_number": "580-371-3799",
        "authorized_official_credential": "M.S. LPC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Tishomingo, OK
• Providers in Tishomingo, OK by specialty
• Case Management Agency in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2011; 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.