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PENNINGTON CREEK LIFE HOUSE
NPI 1164771366
Community/Behavioral Health in Tishomingo, OK

Active since September 04, 2012
801 E MAIN ST, TISHOMINGO, OK 73460(580) 371-3776 Get Directions Write a Review

NPPES record last updated: September 4, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pennington Creek Life House NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENNINGTON CREEK LIFE HOUSE (NPI 1164771366) is a healthcare organization registered as a community/behavioral health in Tishomingo, Oklahoma and active in the NPI registry since September 2012. The organization lists Jan Owens, Owner, as its authorized official.

NPPES Registry Identity

NPI1164771366
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NamePENNINGTON CREEK LIFE HOUSE
Location Address801 E MAIN STTishomingo, OK 73460-2351
Mailing Address801 East Main StreetTishomingo, OK 73460
Phone(580) 371-3776
Organization SubpartNo
Authorized OfficialJan OwensOwner · (580) 371-3776
Enumeration DateSeptember 4, 2012
✔ NPI 1164771366 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
801 E MAIN ST, Tishomingo, OK 73460
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CRAIG KENDALL EDMONDSON BS ED BHRS
Counselor (Mental Health)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (580) 371-3776
MR. RANDAL COY FLINN
Case Manager/Care Coordinator
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (580) 399-2827
KENDRA LANGFORD BHRS BA
Psychologist (Rehabilitation)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (580) 371-3799
MRS. SHELLEY KAY JOHNSON
Psychologist (Rehabilitation)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (580) 371-2369
MR. CAMRON TYLER OWENS
Counselor (Mental Health)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (580) 371-3799
MATHEW THOMAS
Counselor (Mental Health)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (571) 331-7374
MRS. ANDRIA NICOLE PERRY BS,BHRS
Psychologist (Rehabilitation)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (580) 371-3799
MS. SHEILA D JONES
Psychologist (Rehabilitation)
801 E MAIN ST
TISHOMINGO, OK 73460
Johnston County (918) 839-0581

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pennington Creek Life House's NPI number?

The NPI number for Pennington Creek Life House is 1164771366. It was assigned to this organization in the NPPES registry on September 4, 2012.

Where is Pennington Creek Life House located?

Pennington Creek Life House is located at 801 E Main St, Tishomingo, OK 73460. The listed phone number is (580) 371-3776.

What is Pennington Creek Life House's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

When was this NPI record last updated?

The NPPES record for Pennington Creek Life House was last updated on September 4, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.