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General NPI Number Information
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NPI Number | 1205873098
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Entity Type | Organization
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Legal Business Name | STATE OF OKLAHOMA
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 1101 E MONROE AVE
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City | MCALESTER
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State | OK
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Zip | 74501-4815
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Country | US
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Telephone | 918-426-7800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 579
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City | MCALESTER
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State | OK
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Zip | 74502-0579
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Country | US
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Telephone | 918-426-7800
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DEBORAH SUE MORAN
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Credential | LPC, LADC
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Telephone | 918-426-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | NOT REQUIRED
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License Number State | OK
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