Healthcare Provider Details

I. General information

NPI: 1609259365
Provider Name (Legal Business Name): MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S MAIN ST
LINDSAY OK
73052-5634
US

IV. Provider business mailing address

216 S MAIN ST
LINDSAY OK
73052-5634
US

V. Phone/Fax

Practice location:
  • Phone: 405-756-1414
  • Fax:
Mailing address:
  • Phone: 405-756-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NORMA HOWARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-223-5070