Healthcare Provider Details

I. General information

NPI: 1972830933
Provider Name (Legal Business Name): CREOKS BEHAVIORAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
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

14701 COURTNEY LN
GLENPOOL OK
74033-3556
US

V. Phone/Fax

Practice location:
  • Phone: 918-814-5718
  • Fax: 918-322-6168
Mailing address:
  • Phone: 918-814-5718
  • Fax: 918-322-6168

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: MR. PHIL BLACK
Title or Position: DIRESCTOR OF INTENSIVE OUTPATIENT P
Credential: LPC, BCPC
Phone: 918-592-1622