Provider Demographics
NPI:1801359989
Name:TAKE HEART THERAPY, LLC
Entity Type:Organization
Organization Name:TAKE HEART THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-857-5244
Mailing Address - Street 1:3810 HARRELD RD
Mailing Address - Street 2:
Mailing Address - City:BEGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74421-2478
Mailing Address - Country:US
Mailing Address - Phone:918-857-5244
Mailing Address - Fax:
Practice Address - Street 1:519 E 141ST ST STE L
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3588
Practice Address - Country:US
Practice Address - Phone:918-641-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty