Healthcare Provider Details

I. General information

NPI: 1659503035
Provider Name (Legal Business Name): RED ROCK WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N 31ST ST
CLINTON OK
73601-9116
US

IV. Provider business mailing address

90 N 31ST ST
CLINTON OK
73601-9116
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-6021
  • Fax: 580-331-2009
Mailing address:
  • Phone: 580-323-6021
  • Fax: 580-331-2009

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: MR. CYLE CROSNOE
Title or Position: CRISIS UNIT COORDINATOR
Credential: M.ED.
Phone: 580-323-6021