Healthcare Provider Details

I. General information

NPI: 1780223453
Provider Name (Legal Business Name): 20TH DISTRICT DRUG COURT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 N WASHINGTON ST STE 219
ARDMORE OK
73401-7056
US

IV. Provider business mailing address

39 N WASHINGTON ST STE 219
ARDMORE OK
73401-7056
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-5520
  • Fax: 580-226-5710
Mailing address:
  • Phone: 580-226-5520
  • Fax: 580-226-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN M TERRY JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-226-5520