Provider Demographics
NPI:1669945804
Name:HEARTLAND THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:HEARTLAND THERAPEUTIC SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-724-4779
Mailing Address - Street 1:4198 HOBBY HORSE LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-9361
Mailing Address - Country:US
Mailing Address - Phone:918-724-4779
Mailing Address - Fax:888-284-2781
Practice Address - Street 1:102 W ROGERS BLVD. SKIATOOK
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-7407
Practice Address - Country:US
Practice Address - Phone:918-724-4779
Practice Address - Fax:888-284-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1407985229OtherNPPES