Healthcare Provider Details

I. General information

NPI: 1598960015
Provider Name (Legal Business Name): ASSOCIATED THERAPEUTIC SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N MAIN ST
MEDFORD OK
73759-1232
US

IV. Provider business mailing address

1625 W OWEN K GARRIOTT RD SUITE F
ENID OK
73703-5653
US

V. Phone/Fax

Practice location:
  • Phone: 580-395-3673
  • Fax: 580-242-4679
Mailing address:
  • Phone: 580-242-4673
  • Fax: 580-242-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA LYNNE KROEKER
Title or Position: PRESIDENT
Credential: MHR, LPC
Phone: 580-242-4673