Pennington Creek Lifehouse

NPI #1962799593 in Tishomingo, Oklahoma

Provider Information

NPI Number: 1962799593
Entity Type: Organization
Organization Name: Pennington Creek Lifehouse
Primary Specialty: Case Management
Enumeration Date: Jul 4, 2011
Last Updated: Jul 4, 2011

Practice Location

Address: 705 W MAIN ST
City: Tishomingo
State: Oklahoma
ZIP Code: 73460-1734
Phone: (580) 371-3799

Authorized Official

Name: JAN M OWENS, M.S. LPC
Title: OWNER/ THERAPIST
Phone: (580) 371-3799

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Management	251B00000X	Primary

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