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General NPI Number Information
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NPI Number | 1013628684
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Entity Type | Organization
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Legal Business Name | SPECTRUM MY WAY LLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 3351 SANTA ROSA CT
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City | NORMAN
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State | OK
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Zip | 73071-5078
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Country | US
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Telephone | 405-204-2065
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Fax |
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Provider Business Mailing Address
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Address Line | 3351 SANTA ROSA CT
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City | NORMAN
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State | OK
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Zip | 73071-5078
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA VANOVER
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Credential |
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Telephone | 405-204-2065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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