Healthcare Provider Details

I. General information

NPI: 1487076550
Provider Name (Legal Business Name): MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9432 N MAY AVE SUITE D-2
OKLAHOMA CITY OK
73120-2716
US

IV. Provider business mailing address

9432 N MAY AVE SUITE D-2
OKLAHOMA CITY OK
73120-2716
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-8030
  • Fax:
Mailing address:
  • Phone: 405-608-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEANA THARP
Title or Position: DEPUTY EXECUTIVE DIRECTOR
Credential: LPC
Phone: 580-223-5070