Provider Demographics
NPI:1033636683
Name:RESTORING THE BROKENHEARTED
Entity Type:Organization
Organization Name:RESTORING THE BROKENHEARTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-923-5933
Mailing Address - Street 1:5131 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-5258
Mailing Address - Country:US
Mailing Address - Phone:405-706-6081
Mailing Address - Fax:
Practice Address - Street 1:5131 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-5258
Practice Address - Country:US
Practice Address - Phone:405-706-6081
Practice Address - Fax:405-706-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health