Provider Demographics
NPI:1780332635
Name:AT PEACE MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:AT PEACE MENTAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JOHNDROW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC S
Authorized Official - Phone:918-381-5292
Mailing Address - Street 1:1608 E GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8311
Mailing Address - Country:US
Mailing Address - Phone:918-381-5292
Mailing Address - Fax:918-984-9497
Practice Address - Street 1:7804 E 108TH ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7423
Practice Address - Country:US
Practice Address - Phone:918-381-5292
Practice Address - Fax:918-984-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty