Basic Information
| Provider Information | |||||||||
| NPI: | 1194336859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNER PEACE THERAPY AND CONSULTING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 HIGH CIR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730713648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058129905 | ||||||||
| FaxNumber: | 4053102081 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W ROCK CREEK RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730698581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058129905 | ||||||||
| FaxNumber: | 4053102081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2020 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEVENSON | ||||||||
| AuthorizedOfficialFirstName: | LATESHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4058129905 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.