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General NPI Number Information
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NPI Number | 1225647746
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Entity Type | Organization
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Legal Business Name | KEETOOWAH CHEROKEE TREATMENT SERVICES
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 2727 E ADMIRAL PL
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City | TULSA
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State | OK
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Zip | 74110-5436
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Country | US
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Telephone | 918-835-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 E ADMIRAL PL
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City | TULSA
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State | OK
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Zip | 74110-5436
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Country | US
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Telephone | 918-835-3017
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Fax |
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Authorized Official
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Title or Position | AMIN
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Name | JENNIFER LEIGH LEEP
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Credential |
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Telephone | 918-316-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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