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1588755532

NPI Code Detail

MEDICARE: STATE OF OKLAHOMA

MEDICARE: STATE OF OKLAHOMA

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	261QM2500X	Medical Specialty Clinic/Center
2	251S00000X	Community/Behavioral Health Agency
3	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588755532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF OKLAHOMA

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-0400
Country	:	US
Telephone Number	:	405-360-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 ALAMEDA ST
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-5229
Country	:	US
Telephone Number	:	405-573-3901
Fax Number	:	405-573-3958

Authorized Official
Title or Position	:	CEP
Name	:	BRIANNA NORMAN
Credential	:	LCSW
Telephone Number	:	405-360-5100

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/20/2026

Similar Medicare Providers

1992680763 — TONY RAY GAUGHT CPRSS
Practice Location Address:

909 ALAMEDA ST
NORMAN, OK
73071-5229

Practice Phone: 405-360-5100
Practice Fax:

1245800150 — BROOKE ELIZABETH SHATTUCK LPC
Practice Location Address:

909 ALAMEDA ST
NORMAN, OK
73071-5229

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1295708519 — DR. JACK KENNETH GRAY JR. MD
Practice Location Address:

909 ALAMEDA ST
NORMAN, OK
73071-5229

Practice Phone: 405-573-3934
Practice Fax: 405-573-3962

1225040553 — CRYSTAL ANNETTE ROARK LPC
Practice Location Address:

909 ALAMEDA ST
NORMAN, OK
73071-5229

Practice Phone: 405-360-5100
Practice Fax:

1528164357 — SONJA RAE BROWN B.S. BHRS
Practice Location Address:

909 ALAMEDA ST
NORMAN, OK
73071-5229

Practice Phone: 405-573-6494
Practice Fax: 405-573-3958

1831281070 — DR. NICASIO S GUTIERREZ JR. M.D.
Practice Location Address:

909 ALAMEDA ST
NORMAN, OK
73071-5229

Practice Phone: 405-573-3558
Practice Fax: 405-573-3962

Directions to “STATE OF OKLAHOMA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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