Provider Demographics
NPI:1841410776
Name:GOOD LIFE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:GOOD LIFE ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WAHKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-474-3782
Mailing Address - Street 1:33708 POST OFFICE NECK RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5014
Mailing Address - Country:US
Mailing Address - Phone:405-474-3782
Mailing Address - Fax:405-395-5699
Practice Address - Street 1:3200 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-5014
Practice Address - Country:US
Practice Address - Phone:405-474-3782
Practice Address - Fax:405-395-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK952103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200075800AMedicaid