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General NPI Number Information
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NPI Number | 1023411907
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Entity Type | Organization
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Legal Business Name | ADDICTION & BEHAVIORAL HEALTH CENTER, INC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 124 S BROADWAY AVE SUITE 200
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City | ADA
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State | OK
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Zip | 74820-5820
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Country | US
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Telephone | 580-332-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 124 S BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5820
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Country | US
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Telephone | 580-332-3001
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | PHILLIP LANE BENNETT
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Credential | LPC
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Telephone | 405-712-0514
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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 | 2291
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License Number State | OK
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