MEDICARE: MENTAL HEALTH RESOURCES CORP.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	OK846	OK

General Provider Information

NPI Number	:	1407067879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH RESOURCES CORP.

Provider Business Mailing Address
First Line	:	416 W 15TH ST
Second Line	:	BUILDING 500, SUITE E
City	:	EDMOND
State	:	OK
Zip	:	73013-3747
Country	:	US
Telephone Number	:	405-726-2745
Fax Number	:	405-726-2746

Provider Business Practice Location Address
First Line	:	416 W 15TH ST
Second Line	:	BUILDING 500, SUITE E
City	:	EDMOND
State	:	OK
Zip	:	73013-3747
Country	:	US
Telephone Number	:	405-726-2745
Fax Number	:	405-726-2746

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA TRAPP
Credential	:	PHD
Telephone Number	:	405-210-7851

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	09/12/2012

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