Healthcare Provider Details

I. General information

NPI: 1376878843
Provider Name (Legal Business Name): SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARLINGTON ST STE G
ADA OK
74820-4072
US

IV. Provider business mailing address

1201 ARLINGTON ST STE G
ADA OK
74820-4072
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-0274
  • Fax:
Mailing address:
  • Phone: 580-564-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA RAGAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 580-564-7374