Healthcare Provider Details

I. General information

NPI: 1902196421
Provider Name (Legal Business Name): INTEGRIS MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SPENCER RD
SPENCER OK
73084-3649
US

IV. Provider business mailing address

1304 GARLAND AVE
OKLAHOMA CITY OK
73111-4710
US

V. Phone/Fax

Practice location:
  • Phone: 405-427-2441
  • Fax:
Mailing address:
  • Phone: 405-234-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE TINGLER
Title or Position: HUMAN RESOURCES
Credential:
Phone: 405-427-2441