Healthcare Provider Details

I. General information

NPI: 1225107535
Provider Name (Legal Business Name): SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E COURT ST
ATOKA OK
74525-2047
US

IV. Provider business mailing address

303 E COURT ST
ATOKA OK
74525-2047
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-5555
  • Fax: 580-889-1925
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MILTON EVANS
Title or Position: CEO
Credential:
Phone: 580-564-1660