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NPI Code Detail

MEDICARE: CREOKS MENTAL HEALTH SERVICES

MEDICARE: CREOKS MENTAL HEALTH SERVICES
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
1251S00000XCommunity/Behavioral Health Agency100734620LOK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043331499
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREOKS MENTAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 4103 S YALE AVE STE B
Second Line :
City : TULSA
State : OK
Zip : 74135-6002
Country : US
Telephone Number : 918-382-7300
Fax Number : 918-382-7302
Provider Business Practice Location Address
First Line : 711 S MUSKOGEE AVE
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-4717
Country : US
Telephone Number : 918-207-0078
Fax Number : 918-207-0558
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. BRENT M. BLACK
Credential : LPC
Telephone Number : 918-756-9411
Provider Enumeration Date : 04/03/2007
Last Update Date : 10/15/2019

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Directions to “CREOKS MENTAL HEALTH SERVICES ” Practice Location

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