Provider Demographics
NPI:1932929635
Name:RECOVERY AND RESILIENCE OUTDOORS LLC
Entity type:Organization
Organization Name:RECOVERY AND RESILIENCE OUTDOORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-782-2242
Mailing Address - Street 1:39 NE DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-3697
Mailing Address - Country:US
Mailing Address - Phone:334-782-2242
Mailing Address - Fax:
Practice Address - Street 1:39 NE DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-3697
Practice Address - Country:US
Practice Address - Phone:334-782-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10844OtherLICENSE
OK1255099685OtherNPI