PENNINGTON CREEK LIFEHOUSE (NPI# 1962799593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962799593 |
| Entity Type | Organization |
| Organization Name | PENNINGTON CREEK LIFEHOUSE |
| Practice Address |
705 W Main St Tishomingo OK 73460-1734 |
| Practice Telephone | 5803713799 |
| Practice Fax Number | 5803712056 |
| Mailing Telephone | 5803713799 |
| Mailing Fax Number | 5803712056 |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2011-07-04 |
| Authorized Official Name | JAN M OWENS (OWNER/ THERAPIST) |
| Authorized Official Telephone | 5803713799 |
| Authorized Official Credential | M.S. LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251B00000X | Case Management | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326393554 | Pennington Creek Lifehouse | Community/Behavioral Health | 130 N Greenwood Ave Ste 200, Tulsa, OK 74120-1409 | 2012-07-13 |
| 1831464304 | Pennington Creek Lifehouse | Community/Behavioral Health | 801 E Main St, Tishomingo, OK 73460-2351 | 2012-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | PENNINGTON CREEK LIFEHOUSE, LLC | 801 E Main St, Tishomingo, OK 73460 |
| Street Address |
705 W MAIN ST |
| City | TISHOMINGO |
| State | OK |
| Zip Code | 73460-1734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033490412 | Stephynne Dawn Stevens | Rehabilitation Counselor | 705 W Main St, Tishomingo, OK 73460-1734 | 2011-08-30 |
| 1023334836 | Jayne Hull | Counselor | 705 W Main St, Tishomingo, OK 73460-1734 | 2010-04-19 |
| 1376875377 | Tyson Benjamin Ratzlaff | Counselor | 705 W Main St, Tishomingo, OK 73460-1734 | 2010-02-02 |
| 1558692137 | Daniel Floyd James | Counselor | 705 W Main St, Tishomingo, OK 73460-1734 | 2010-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912380742 | Lori Pigg | Speech-Language Pathologist | 508 N. Neshoba, Tishomingo, OK 73460 | 2015-06-29 |
| 1407241748 | Brittany Walker | Case Management | 850 E. Highway 22, Tishomingo, OK 73460 | 2015-04-03 |
| 1427460641 | Elizabeth Mcdonald | Counselor | 512 East 24th, Tishomingo, OK 73460 | 2014-05-22 |
| 1619387131 | Sheri Slaughter | Counselor | 102 N. Neshoba, Tishomingo, OK 73460 | 2014-05-06 |
| 1336559848 | Heather Marlatt | Counselor | 102 North Neshoba, Tishomingo, OK 73460 | 2014-05-06 |
| 1811231939 | Wanda Luann Beesley Gray | Emergency Medical Technician, Paramedic | 3100 E St Hwy 78, Tishomingo, OK 73460 | 2012-11-15 |
| 1497014724 | Jessica Kay Johnston | Counselor | Outpatient Services-tishomingo; 817 E. 6th St., Strong Family Development, Tishomingo, OK 73460 | 2012-05-07 |
| 1487910949 | Rhonda Gayle Harrison | Counselor | 817 E. 6th St., Medical Family Therapy, Tishomingo, OK 73460 | 2012-04-09 |
| 1265704183 | Parks Family Dental | Preferred Provider Organization | 1520 E. Main Street, Tishomingo, OK 73460 | 2012-02-08 |
| 1770852295 | Gina Marice Frazier | Social Worker | Outpatient Services- Tishomingo, 817 E. 6th St., Tishomingo, OK 73460 | 2011-12-29 |
| Find all providers in zip 73460 | ||||
| Taxonomy Code | 251B00000X |
| Grouping | Agencies |
| Classification | Case Management |
| An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407241748 | Brittany Walker | Case Management | 850 E. Highway 22, Tishomingo, OK 73460 | 2015-04-03 |
| 1164567293 | Southern Oklahoma Treatment Services, Inc. | Case Management | 106 N Burris St, Tishomingo, OK 73460-2318 | 2007-02-20 |
| 1841612751 | Ruth Mcgraw | Case Management | 801 E Main St, Tishomingo, OK 73460-2351 | 2014-01-11 |
| 1811249881 | Lauren Brooke Huff | Case Management | 801 E Main St, Tishomingo, OK 73460-2351 | 2012-10-15 |
| 1841548773 | Teresa Janette Runyon | Case Management | 801 E Main St, Tishomingo, OK 73460-2351 | 2012-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023618758 | Jonathan Nyanquoi Nyanyoun | Case Management | 12508 E 34th St, Tulsa, OK 74146-2218 | 2020-10-30 |
| 1437758323 | Free Your Mind Counseling | Case Management | 10802 Quail Plaza Dr Ste 208, Oklahoma City, OK 73120-3121 | 2020-10-21 |
| 1750997680 | Vanessa Flores | Case Management | 13177 Ne Tony Creek Rd, Elgin, OK 73538-2006 | 2020-09-16 |
| 1619588134 | Coral LLC | Case Management | 12352 Market Dr, Oklahoma City, OK 73114-8136 | 2020-08-10 |
| 1003430497 | Meals On Wheels of Metro Tulsa, Inc. | Case Management | 12620 E 31st St, Tulsa, OK 74146-2307 | 2020-06-02 |
| 1972137107 | Delayna Lynne Marion | Case Management | 109902 S 4570 Rd, Sallisaw, OK 74955-5086 | 2020-02-26 |
| 1649802679 | Amee Renae Brown | Case Management | 9225 E 570 Rd, Kansas, OK 74347-1620 | 2020-02-07 |
| 1780223453 | 20th District Drug Court | Case Management | 39 N Washington St Ste 219, Ardmore, OK 73401-7056 | 2019-12-30 |
| 1528629813 | Medefy Health LLC | Case Management | 8596 E 101st St Ste C, Tulsa, OK 74133-7037 | 2019-06-26 |
| 1033778287 | Sheena M Spies | Case Management | 816 W Oakland St, Broken Arrow, OK 74012-1662 | 2019-06-11 |
| Find all providers with the same taxonomy | ||||
| City | TISHOMINGO |
| Zip Code | 73460 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.