Healthcare Provider Details

I. General information

NPI: 1841479110
Provider Name (Legal Business Name): CREOKS BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W BROADWAY ST
OKEMAH OK
74859-2618
US

IV. Provider business mailing address

209 W BROADWAY ST P.O BOX 149
OKEMAH OK
74859-2618
US

V. Phone/Fax

Practice location:
  • Phone: 918-623-2922
  • Fax: 918-623-9316
Mailing address:
  • Phone: 918-623-2922
  • Fax: 918-623-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALFREDA M MOORE
Title or Position: BHRS
Credential: BS
Phone: 918-623-2922