Provider Demographics
NPI:1770164329
Name:PINKY PROMISE KEEPERS PLLC
Entity type:Organization
Organization Name:PINKY PROMISE KEEPERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUQUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-455-7244
Mailing Address - Street 1:5710 E RENO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-2005
Mailing Address - Country:US
Mailing Address - Phone:405-455-7244
Mailing Address - Fax:405-455-7292
Practice Address - Street 1:5710 E RENO AVE # C
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2005
Practice Address - Country:US
Practice Address - Phone:405-455-7244
Practice Address - Fax:405-455-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1487972444Medicaid