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NPI Code Detail

MEDICARE: CREOKS MENTAL HEALTH SERVICES

MEDICARE: CREOKS MENTAL HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency100734620GOK
2251S00000XCommunity/Behavioral Health Agency100734620COK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912120452
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREOKS MENTAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 4103 S YALE AVE STE B
Second Line :
City : TULSA
State : OK
Zip : 74135-6002
Country : US
Telephone Number : 918-382-7300
Fax Number : 918-382-7302
Provider Business Practice Location Address
First Line : 23 E ROSS AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066-6423
Country : US
Telephone Number : 918-227-2016
Fax Number : 918-756-2126
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. BRENT M BLACK
Credential : LPC
Telephone Number : 918-382-7300
Provider Enumeration Date : 04/11/2007
Last Update Date : 04/05/2024

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1710047428 — BRIAN ORMSBY LPC
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Practice Fax:

Directions to “CREOKS MENTAL HEALTH SERVICES ” Practice Location

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