Provider Demographics
NPI:1124366836
Name:INNER PEACE THERAPY, INC.
Entity Type:Organization
Organization Name:INNER PEACE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO, CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-879-9977
Mailing Address - Street 1:3727 NW 63RD ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1931
Mailing Address - Country:US
Mailing Address - Phone:405-879-9977
Mailing Address - Fax:405-879-9939
Practice Address - Street 1:3727 NW 63RD ST
Practice Address - Street 2:SUITE 112
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1931
Practice Address - Country:US
Practice Address - Phone:405-879-9977
Practice Address - Fax:405-879-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4500-P251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health