Healthcare Provider Details

I. General information

NPI: 1225965981
Provider Name (Legal Business Name): IRONGATE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 WESTSIDE DR
DURANT OK
74701-3084
US

IV. Provider business mailing address

698 WESTSIDE DR
DURANT OK
74701-3084
US

V. Phone/Fax

Practice location:
  • Phone: 206-492-0723
  • Fax:
Mailing address:
  • Phone: 206-492-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE PORTER
Title or Position: OWNER
Credential:
Phone: 206-492-0723