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Integrated Renegade, LLC

NPI #1366223265 in Glenpool, Oklahoma

Provider Information

NPI Number
1366223265
Entity Type
Organization
Organization Name
Integrated Renegade, LLC
Primary Specialty
Community/Behavioral Health
Enumeration Date
Oct 9, 2023
Last Updated
Oct 9, 2023

Practice Location

Address
1264 E 139TH PL
City
Glenpool
State
Oklahoma
ZIP Code
74033-3125
Phone
(918) 321-0697

Authorized Official

Name
PETRA RUSSELL, LPC
Title
OWNER
Phone
(918) 321-0697

Specialties & Taxonomy Codes

Specialty
Community/Behavioral Health

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