Healthcare Provider Details

I. General information

NPI: 1578821062
Provider Name (Legal Business Name): ABOVE ALL BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S DOUGLAS BLVD SUITE 102
MIDWEST CITY OK
73130-5270
US

IV. Provider business mailing address

1390 S DOUGLAS BLVD SUITE 102
MIDWEST CITY OK
73130-5270
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-5312
  • Fax: 405-455-5279
Mailing address:
  • Phone: 405-455-5312
  • Fax: 405-455-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4638
License Number StateOK

VIII. Authorized Official

Name: MR. JEFFREY SCOTT PLUNKETT
Title or Position: CEO
Credential: LPC
Phone: 405-455-5312