Healthcare Provider Details

I. General information

NPI: 1730712316
Provider Name (Legal Business Name): CREOKS MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19320 E ADMIRAL PL STE B
CATOOSA OK
74015-3240
US

IV. Provider business mailing address

PO BOX 700360
TULSA OK
74170-0360
US

V. Phone/Fax

Practice location:
  • Phone: 918-340-5503
  • Fax: 918-340-5505
Mailing address:
  • Phone: 918-382-7300
  • 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: TABITHA TALBOT
Title or Position: GH HELPDESK MANAGER
Credential:
Phone: 918-382-7300