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Organization
LIBERTAD WELLNESS CENTER LLC
Active
Organization
LIBERTAD WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRUDENCIA IJEOMA TANKEU PMHNP-BC (MANAGER)
(405) 689-9303
Entity
Organization
Contact information
Practice address
2915 N CLASSEN BLVD STE 120-F509, OKLAHOMA CITY, OK 73106-5400
(405) 689-9303
(405) 229-5071
Mailing address
2915 N CLASSEN BLVD STE 120-F509, OKLAHOMA CITY, OK 73106-5400
(405) 689-9303
(405) 229-5071
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/10/2024
Last updated
09/04/2024
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