=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750709903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN OKLAHOMA TREATMENT SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2014
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 SW WASHINGTON AVE
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73501-7231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-355-7500
-----------------------------------------------------
Fax | 855-286-8580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1710
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73439-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-564-7374
-----------------------------------------------------
Fax | 855-286-8580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | BRE'YON JAMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-490-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2800X
-----------------------------------------------------
Taxonomy Name | Methadone Clinic
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------