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General NPI Number Information
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NPI Number | 1295276012
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Entity Type | Organization
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Legal Business Name | SEASONS OF CHANGE BEHAVIORAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 1919 E 2ND ST APT 334
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City | EDMOND
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State | OK
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Zip | 73034-6230
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Country | US
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Telephone | 405-408-8445
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 E 2ND ST APT 334
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City | EDMOND
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State | OK
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Zip | 73034-6230
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Country | US
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Telephone | 405-408-8445
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | KRUTI SURESHCHANDRA CHALIAWALA
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Credential |
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Telephone | 405-408-8445
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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 |
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License Number State |
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