MEDICARE: NAMI OKLAHOMA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003136607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAMI OKLAHOMA, INC.

Provider Business Mailing Address
First Line	:	1920 N DREXEL BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3925
Country	:	US
Telephone Number	:	405-230-1900
Fax Number	:	405-230-1903

Provider Business Practice Location Address
First Line	:	1920 N DREXEL BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3925
Country	:	US
Telephone Number	:	405-230-1900
Fax Number	:	405-230-1903

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. JINNEH TIPRIANA DYSON
Credential	:	MS
Telephone Number	:	405-230-1900

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	06/04/2010

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