Healthcare Provider Details

I. General information

NPI: 1346509627
Provider Name (Legal Business Name): SUMMIT BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 23RD ST SUITE 209
OKLAHOMA CITY OK
73103-1469
US

IV. Provider business mailing address

600 NW 23RD ST SUITE 209
OKLAHOMA CITY OK
73103-1469
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-0423
  • Fax: 405-601-9626
Mailing address:
  • Phone: 405-601-0423
  • Fax: 405-601-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000000
License Number StateOK

VIII. Authorized Official

Name: MS. ANGELIQUE M WILLIAMSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-641-3894