Organization
LIFE VISION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERA BIAGGI LCSW (CLINICAL DIRECTOR)
(580) 716-4787
Entity
Organization
Contact information
Practice address
2101 N ASH ST, PONCA CITY, OK 74601-1106
(580) 716-4787
Mailing address
11605 S Q ST, PONCA CITY, OK 74601-7565
(580) 716-4787
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3696
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200288910C
—
OK
Enumeration date
10/07/2013
Last updated
10/07/2013
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