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General NPI Number Information
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NPI Number | 1417767534
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Entity Type | Organization
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Legal Business Name | CREOKS MENTAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 19320 E ADMIRAL PL STE B
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City | CATOOSA
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State | OK
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Zip | 74015-3240
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Country | US
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Telephone | 918-340-5503
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Fax | 918-340-5505
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Provider Business Mailing Address
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Address Line | PO BOX 700360
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City | TULSA
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State | OK
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Zip | 74170-0360
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Country | US
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Telephone | 918-382-7300
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | KERRI WATSON
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Credential |
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Telephone | 918-698-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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