Healthcare Provider Details

I. General information

NPI: 1477150530
Provider Name (Legal Business Name): RED ROCK BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 N HARVEY AVE
OKLAHOMA CITY OK
73103-3017
US

IV. Provider business mailing address

4400 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5104
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-3959
  • Fax:
Mailing address:
  • Phone: 405-525-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. EDMUND T SCOTT
Title or Position: MENTAL HEALTH ASSOCIATE
Credential:
Phone: 405-525-3959