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General NPI Number Information
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NPI Number | 1316144272
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Entity Type | Organization
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Legal Business Name | CREOKS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 W 6TH ST
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City | OKMULGEE
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State | OK
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Zip | 74447-5000
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Country | US
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Telephone | 918-758-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W 6TH ST
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City | OKMULGEE
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State | OK
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Zip | 74447-5000
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Country | US
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Telephone | 918-758-4110
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | MRS. TERESA MARIE WILLIAMS
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Credential | LADC
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Telephone | 918-758-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 620
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License Number State | OK
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