Healthcare Provider Details

I. General information

NPI: 1497950752
Provider Name (Legal Business Name): RITA M BALLINGER CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 2ND ST
TAHLEQUAH OK
74464-4723
US

IV. Provider business mailing address

2512 GIBSON ST
MUSKOGEE OK
74403-2711
US

V. Phone/Fax

Practice location:
  • Phone: 918-431-0418
  • Fax:
Mailing address:
  • Phone: 918-441-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number281
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: