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General NPI Number Information
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NPI Number | 1962958900
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Entity Type | Organization
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Legal Business Name | ADDICTION & BEHAVIORAL HEALTH SPECIALIST INCORPORATED
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 2905 S HARR DR STE 103
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City | MIDWEST CITY
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State | OK
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Zip | 73110-3049
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Country | US
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Telephone | 405-568-2744
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94872
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City | OKLAHOMA CITY
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State | OK
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Zip | 73143-4872
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Country | US
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Telephone | 405-568-2744
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Fax |
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Authorized Official
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Title or Position | CEO/THERAPIST
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Name | MS. NICOLE BROWN
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Credential |
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Telephone | 405-568-2744
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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 | 4666
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License Number State | OK
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