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General NPI Number Information
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NPI Number | 1962706333
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Entity Type | Organization
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Legal Business Name | DALLAS FAMILY SERVICES
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 920 S BOULEVARD # 103
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City | EDMOND
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State | OK
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Zip | 73034-4731
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Country | US
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Telephone | 405-245-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 920 S BOULEVARD # 103
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City | EDMOND
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State | OK
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Zip | 73034-4731
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Country | US
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Telephone | 405-245-7590
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Fax |
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Authorized Official
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Title or Position | CASE MANAGEMENT
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Name | MR. GLENN MARLON BROWN
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Credential |
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Telephone | 405-824-3463
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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 | 2800
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License Number State | OK
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