MEDICARE: CHICKASAW NATION - FAMILY 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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1588968275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICKASAW NATION - FAMILY SERVICES

Provider Business Mailing Address
First Line	:	1300 HOPPE BLVD STE 1
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2319
Country	:	US
Telephone Number	:	580-436-7211
Fax Number	:	580-272-5757

Provider Business Practice Location Address
First Line	:	1300 HOPPE BLVD STE 1
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2319
Country	:	US
Telephone Number	:	580-436-7211
Fax Number	:	580-272-5757

Authorized Official
Title or Position	:	RM MANAGER
Name	:	RENEE HOGUE
Credential	:
Telephone Number	:	580-436-7211

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	03/29/2019

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