Organization
PENNINGTON CREEK LIFEHOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN M OWENS M.S. LPC (OWNER/ THERAPIST)
(580) 371-3799
Entity
Organization
Contact information
Practice address
705 W MAIN ST, TISHOMINGO, OK 73460-1734
(580) 371-3799
(580) 371-2056
Mailing address
705 W MAIN ST, TISHOMINGO, OK 73460-1734
(580) 371-3799
(580) 371-2056
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
07/04/2011
Last updated
07/04/2011
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