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General NPI Number Information
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NPI Number | 1629272364
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Entity Type | Organization
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Legal Business Name | CITIZEN'S ADVISORY COMMITTEE FOR PITTSBURG COUNTY YOUTH EMERGENCY SHEL
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 MCKINLEY ST
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City | EUFAULA
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State | OK
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Zip | 74432-3052
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Country | US
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Telephone | 918-689-2900
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Fax | 918-689-9980
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Provider Business Mailing Address
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Address Line | 904 N 9TH ST
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City | MCALESTER
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State | OK
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Zip | 74501-4212
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Country | US
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Telephone | 918-423-8845
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Fax | 918-423-8898
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GREGORY THOMAS CONTRERAS
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Credential | M.S.
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Telephone | 918-423-8845
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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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