Healthcare Provider Details

I. General information

NPI: 1093072126
Provider Name (Legal Business Name): SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W BROADWAY AVE STE 2
SULPHUR OK
73086-6510
US

IV. Provider business mailing address

PO BOX 1710
KINGSTON OK
73439-1710
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-2783
  • Fax:
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: MISS VIRGINIA RAGAN
Title or Position: C.E.O.
Credential:
Phone: 580-564-7374