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General NPI Number Information
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NPI Number | 1942573076
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ADDICTION AND MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 210 E CREEK AVENUE
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City | SALLISAW
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State | OK
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Zip | 74955
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Country | US
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Telephone | 918-208-3059
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Fax |
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Provider Business Mailing Address
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Address Line | 107 E CREEK AVE
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City | SALLISAW
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State | OK
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Zip | 74955-4652
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DARREN STITIES
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Credential | LPC,LADC
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Telephone | 918-208-3059
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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 | R87617
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License Number State | OK
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