Healthcare Provider Details

I. General information

NPI: 1720383516
Provider Name (Legal Business Name): CREOKS BEHAVIORAL HEALTH SERVICCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 E SKELLY DR STE 200
TULSA OK
74105-6253
US

IV. Provider business mailing address

2725 E SKELLY DR STE 200
TULSA OK
74105-6253
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-1622
  • Fax: 918-392-3328
Mailing address:
  • Phone: 918-592-1622
  • Fax: 918-392-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberH080870444
License Number StateOK

VIII. Authorized Official

Name: MS. SHONDRA DEON MARZETT
Title or Position: REHABILITATION SPECIALIST
Credential: BA; MS
Phone: 918-851-2129