Provider Demographics
NPI:1417310186
Name:EBP & ME, LLC
Entity Type:Organization
Organization Name:EBP & ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE LLC AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-343-1585
Mailing Address - Street 1:5116 SW 126TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73173-8821
Mailing Address - Country:US
Mailing Address - Phone:405-343-1585
Mailing Address - Fax:
Practice Address - Street 1:5116 SW 126TH PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73173-8821
Practice Address - Country:US
Practice Address - Phone:405-343-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC010058251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health