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General NPI Number Information
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NPI Number | 1326136722
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Entity Type | Organization
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Legal Business Name | QUAPAW COUNSELING SERVICES
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 58150 66TH ROAD EAST
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City | MIAMI
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State | OK
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Zip | 74355-0876
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Country | US
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Telephone | 918-542-1786
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Fax | 918-542-3052
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Provider Business Mailing Address
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Address Line | PO BOX 876 58150 E. 66TH RD
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City | MIAMI
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State | OK
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Zip | 74355-0876
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Country | US
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Telephone | 918-542-1786
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Fax | 918-542-3052
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. THOMAS E ASHLEY
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Credential | M.S
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Telephone | 918-542-1786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | CERTIFICATION
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License Number State | OK
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