Provider Demographics
NPI:1336423086
Name:SERENITY BEHAVIORAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SERENITY BEHAVIORAL SERVICES, PLLC
Other - Org Name:SERENITY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALISA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBS, LBP
Authorized Official - Phone:580-271-1638
Mailing Address - Street 1:301 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2238
Mailing Address - Country:US
Mailing Address - Phone:580-271-7055
Mailing Address - Fax:580-271-7055
Practice Address - Street 1:301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2238
Practice Address - Country:US
Practice Address - Phone:580-271-7055
Practice Address - Fax:580-271-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty