Healthcare Provider Details

I. General information

NPI: 1245794411
Provider Name (Legal Business Name): OKLAHOMA PSYCHIATRIC FAMILY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S PARK LANE UNIT B
ALTUS OK
73521-5754
US

IV. Provider business mailing address

PO BOX 328
OLUSTEE OK
73560-0328
US

V. Phone/Fax

Practice location:
  • Phone: 580-248-3900
  • Fax: 580-248-1987
Mailing address:
  • Phone: 580-248-3900
  • Fax: 580-248-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VERNA FAY HENNING
Title or Position: DIRECTOR
Credential: LPC
Phone: 580-248-3900