Healthcare Provider Details

I. General information

NPI: 1568000966
Provider Name (Legal Business Name): SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E 24TH ST
TISHOMINGO OK
73460-3214
US

IV. Provider business mailing address

PO BOX 1710
KINGSTON OK
73439-1710
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-3672
  • Fax:
Mailing address:
  • Phone: 580-564-7374
  • Fax: 855-286-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRE'YON JAMES
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 918-490-3800