Healthcare Provider Details

I. General information

NPI: 1457622540
Provider Name (Legal Business Name): SECOND CHANCE AND REENTRY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N BICKFORD AVE
EL RENO OK
73036-2750
US

IV. Provider business mailing address

106 N BICKFORD AVE
EL RENO OK
73036-2750
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-7227
  • Fax: 405-376-3606
Mailing address:
  • Phone: 405-262-7227
  • Fax: 405-376-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA M COMPTON
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC, LADC
Phone: 405-445-8687