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NPI Code Detail

MEDICARE: MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA

MEDICARE: MENTAL HEALTH SERVICES OF SOUTHERN 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1679619878
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Provider Business Mailing Address
First Line : PO BOX 189
Second Line :
City : ARDMORE
State : OK
Zip : 73402-0189
Country : US
Telephone Number : 580-223-5070
Fax Number : 580-223-5617
Provider Business Practice Location Address
First Line : 301 W 4TH ST
Second Line :
City : ADA
State : OK
Zip : 74820-3411
Country : US
Telephone Number : 580-223-5070
Fax Number : 580-223-5617
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ROBERT E LEE
Credential : LCSW
Telephone Number : 580-223-5070
Provider Enumeration Date : 01/29/2007
Last Update Date : 12/12/2007

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Directions to “MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA ” Practice Location

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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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