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General NPI Number Information
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NPI Number | 1083983639
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Entity Type | Organization
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Legal Business Name | CRISIS CONTROL CENTER
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 115 N 12TH AVE SUITE C
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City | DURANT
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State | OK
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Zip | 74701-4767
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Country | US
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Telephone | 580-924-3056
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 113
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City | DURANT
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State | OK
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Zip | 74702-0113
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Country | US
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Telephone | 580-924-3056
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | GLORIA A STEPHENS
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Credential | CM
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Telephone | 580-924-3056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 7096
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License Number State | OK
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