Healthcare Provider Details

I. General information

NPI: 1881138857
Provider Name (Legal Business Name): NEW HORIZONS TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2016
Last Update Date: 12/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E LAFAYETTE AVE STE A
COALGATE OK
74538-2677
US

IV. Provider business mailing address

6 E LAFAYETTE AVE STE A
COALGATE OK
74538-2677
US

V. Phone/Fax

Practice location:
  • Phone: 580-927-3168
  • Fax: 580-927-2346
Mailing address:
  • Phone: 580-927-3168
  • Fax: 580-927-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5730
License Number StateOK

VIII. Authorized Official

Name: JACKIE LEANN HORTON
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 580-927-3168