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General NPI Number Information
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NPI Number | 1235351552
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Entity Type | Organization
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Legal Business Name | NORTHWEST DOMESTIC CRISIS SERVICES, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1330 OKLAHOMA BLVD.
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City | ALVA
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State | OK
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Zip | 73717
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Country | US
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Telephone | 580-327-6648
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Fax | 580-327-6980
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Provider Business Mailing Address
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Address Line | 1323 KANSAS ST.
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City | WOODWARD
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State | OK
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Zip | 73801
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Country | US
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Telephone | 580-256-1215
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Fax | 580-256-1245
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PAUL FOCKLER
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Credential |
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Telephone | 580-256-1215
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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 | 101YP2500X
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License Number State | OK
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