Provider Demographics
NPI:1679122287
Name:NEW THERAPEUTIC ENVIRONMENT LLC
Entity type:Organization
Organization Name:NEW THERAPEUTIC ENVIRONMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NJAMBED
Authorized Official - Last Name:CHONGWA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-532-9267
Mailing Address - Street 1:4301 NW 63RD ST STE 307
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1504
Mailing Address - Country:US
Mailing Address - Phone:405-532-9267
Mailing Address - Fax:
Practice Address - Street 1:4301 NW 63RD ST STE 307
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1504
Practice Address - Country:US
Practice Address - Phone:405-532-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health