Provider Demographics
NPI:1417448770
Name:LEANING RED OAK, LLC
Entity Type:Organization
Organization Name:LEANING RED OAK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWOAP
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:806-791-1800
Mailing Address - Street 1:3305 66TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5736
Mailing Address - Country:US
Mailing Address - Phone:806-791-1800
Mailing Address - Fax:806-791-1801
Practice Address - Street 1:3305 66TH ST STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5736
Practice Address - Country:US
Practice Address - Phone:806-791-1800
Practice Address - Fax:806-791-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62246261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health