Provider Demographics
NPI:1083126957
Name:SERENITY THERAPY PC
Entity Type:Organization
Organization Name:SERENITY THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-973-0054
Mailing Address - Street 1:531 E A ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4117
Mailing Address - Country:US
Mailing Address - Phone:918-973-0054
Mailing Address - Fax:918-528-3506
Practice Address - Street 1:531 E A ST STE 101B
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4117
Practice Address - Country:US
Practice Address - Phone:918-973-0054
Practice Address - Fax:918-528-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6367101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty