Healthcare Provider Details

I. General information

NPI: 1659511954
Provider Name (Legal Business Name): HEALTHY OPTIONS FOR PREVENTION AND EFFECTIVE TREATMENT OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 S WESTERN AVE 305
OKLAHOMA CITY OK
73109-4520
US

IV. Provider business mailing address

5350 S WESTERN AVE 305
OKLAHOMA CITY OK
73109-4520
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-2949
  • Fax: 877-245-1779
Mailing address:
  • Phone: 405-632-2949
  • Fax: 877-245-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MELANESE PARKS
Title or Position: PRINCIPAL MEMBER
Credential:
Phone: 405-431-0232