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General NPI Number Information
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NPI Number | 1033456355
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Entity Type | Organization
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Legal Business Name | SOUTHERN OKLAHOMA TREATMENT SERVICES
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 1307 SW WASHINGTON AVE
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City | LAWTON
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State | OK
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Zip | 73501-7231
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Country | US
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Telephone | 405-208-9354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48
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City | MEAD
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State | OK
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Zip | 73449-0048
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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 | ADMINISTRATION
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Name | SHANDY SHUBIN
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Credential |
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Telephone | 405-208-9354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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