Provider Demographics
NPI:1184085367
Name:TWENTY-NINE 11 INC
Entity type:Organization
Organization Name:TWENTY-NINE 11 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-337-0055
Mailing Address - Street 1:19501 S ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-9626
Mailing Address - Country:US
Mailing Address - Phone:405-760-6638
Mailing Address - Fax:405-481-7219
Practice Address - Street 1:44038 EAST 45TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-9683
Practice Address - Country:US
Practice Address - Phone:405-827-2514
Practice Address - Fax:405-584-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty