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General NPI Number Information
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NPI Number | 1437222734
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Entity Type | Organization
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Legal Business Name | STATE OF OKLAHOMA
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 604 CHOCTAW NORTHWEST CENTER FOR BEHAVIORAL HEALTH
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City | ALVA
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State | OK
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Zip | 73717
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Country | US
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Telephone | 580-327-1112
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Fax | 580-327-3067
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Provider Business Mailing Address
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Address Line | 1222 10TH ST SUITE 211 NORTHWEST CENTER FOR BEHAVIORAL HEALTH
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City | WOODWARD
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State | OK
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Zip | 73801-3156
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Country | US
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Telephone | 580-571-3217
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Fax | 580-256-8609
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TRUDY HOFFMAN
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Credential |
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Telephone | 580-571-3233
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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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