Healthcare Provider Details

I. General information

NPI: 1700221843
Provider Name (Legal Business Name): SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4149 HIGHLINE BLVD SUITE 390,400
OKLAHOMA CITY OK
73108-2103
US

IV. Provider business mailing address

PO BOX 1710
KINGSTON OK
73439-1710
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-1000
  • Fax: 405-949-1063
Mailing address:
  • Phone: 580-745-9610
  • Fax: 580-745-9650

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: SHARON MURPHY
Title or Position: V. P. OF ADMINISTRATION
Credential:
Phone: 580-745-9610