Provider Demographics
NPI:1144073040
Name:IDYLL BEHAVIORAL HEALTH SOLUTIONS
Entity type:Organization
Organization Name:IDYLL BEHAVIORAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:EBELECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:EKWENUGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-848-7011
Mailing Address - Street 1:15004 SALEM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2454
Mailing Address - Country:US
Mailing Address - Phone:682-521-5224
Mailing Address - Fax:
Practice Address - Street 1:15004 SALEM CREEK RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2454
Practice Address - Country:US
Practice Address - Phone:832-848-7011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health