Healthcare Provider Details

I. General information

NPI: 1356442743
Provider Name (Legal Business Name): DRUG RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N WALNUT
OKC OK
73105-2832
US

IV. Provider business mailing address

3033 N WALNUT
OKC OK
73105-2832
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-1102
  • Fax: 405-236-3421
Mailing address:
  • Phone: 405-230-1102
  • Fax: 405-236-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCARF 205299
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. EDIE NAYFA
Title or Position: EXECUTIVE VP
Credential: LPC,LADC
Phone: 405-826-0105