Provider Demographics
NPI:1417386509
Name:HEARTLAND'S HOPE MENTAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:HEARTLAND'S HOPE MENTAL HEALTH CENTER, LLC
Other - Org Name:TERA ROBINSON, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED, LPC
Authorized Official - Phone:620-604-5111
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:TURPIN
Mailing Address - State:OK
Mailing Address - Zip Code:73950-0132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 N KANSAS AVE STE B
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-3346
Practice Address - Country:US
Practice Address - Phone:620-604-5111
Practice Address - Fax:855-687-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2478101YP2500X
KS2279235Z00000X
OK4025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty