Provider Demographics
NPI:1336497494
Name:INSTILLING HOPE
Entity Type:Organization
Organization Name:INSTILLING HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-556-0912
Mailing Address - Street 1:3130 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1902
Mailing Address - Country:US
Mailing Address - Phone:405-556-0912
Mailing Address - Fax:405-808-8856
Practice Address - Street 1:3130 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1902
Practice Address - Country:US
Practice Address - Phone:405-556-0912
Practice Address - Fax:405-808-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4840251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2002424370OtherOKLAHOMA HEALTH CARE AUTHORITY