Healthcare Provider Details

I. General information

NPI: 1043434368
Provider Name (Legal Business Name): SPECIALIZED OUTPATIENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 CLASSEN CIRCLE
OKLAHOMA CITY OK
73118-4429
US

IV. Provider business mailing address

5208 CLASSEN CIRCLE
OKLAHOMA CITY OK
73118-4429
US

V. Phone/Fax

Practice location:
  • Phone: 405-810-1766
  • Fax: 405-810-0331
Mailing address:
  • Phone: 405-810-1766
  • Fax: 405-810-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES L PATTERSON
Title or Position: EXECUTIVE DIRECTOR
Credential: CADC
Phone: 405-810-1766