Provider Demographics
NPI:1679989586
Name:A HEALING PATH
Entity type:Organization
Organization Name:A HEALING PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:918-575-0687
Mailing Address - Street 1:621 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-4215
Mailing Address - Country:US
Mailing Address - Phone:918-696-2181
Mailing Address - Fax:918-696-2182
Practice Address - Street 1:621 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4215
Practice Address - Country:US
Practice Address - Phone:918-696-2181
Practice Address - Fax:918-696-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3693251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20050420AMedicaid