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General NPI Number Information
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NPI Number | 1245517929
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Entity Type | Organization
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Legal Business Name | THUNDERBIRD CLUBHOUSE
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 1251 TRIAD VILLAGE DR
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City | NORMAN
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State | OK
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Zip | 73071-2967
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Country | US
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Telephone | 405-321-7331
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Fax | 405-364-6058
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Provider Business Mailing Address
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Address Line | 1251 TRIAD VILLAGE DR
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City | NORMAN
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State | OK
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Zip | 73071-2967
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Country | US
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Telephone | 405-321-7331
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Fax | 405-364-6058
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PAMELA SANFORD
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Credential | LCSW
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Telephone | 405-321-7331
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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 |
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License Number State |
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