Healthcare Provider Details

I. General information

NPI: 1821405770
Provider Name (Legal Business Name): SEASONS OF CHANGE BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S FRETZ AVE SUITE C
EDMOND OK
73003-5570
US

IV. Provider business mailing address

409 S FRETZ AVE SUITE C
EDMOND OK
73003-5570
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-9808
  • Fax: 405-726-9809
Mailing address:
  • Phone: 405-726-9808
  • Fax: 405-726-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5267
License Number StateOK

VIII. Authorized Official

Name: LORIEN OLIVIA HOLMAN
Title or Position: CEO
Credential: LPC
Phone: 405-726-9808