Healthcare Provider Details

I. General information

NPI: 1891920534
Provider Name (Legal Business Name): NORMAN ADDICTION AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W LINN ST
NORMAN OK
73069-5837
US

IV. Provider business mailing address

PO BOX 730
NORMAN OK
73070-0730
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-0022
  • Fax: 405-360-4918
Mailing address:
  • Phone: 405-321-0022
  • Fax: 405-360-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1629130166
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1629130166
License Number StateOK

VIII. Authorized Official

Name: MR. EDWARD JOHN HENNE
Title or Position: COUNSELOR
Credential: BA, CADC
Phone: 405-321-0022