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
1	251S00000X	Community/Behavioral Health Agency	CMHC-561	OK

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

General Provider Information

NPI Number	:	1700136900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREOKS MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 760
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-0760
Country	:	US
Telephone Number	:	918-756-9411
Fax Number	:	918-756-2126

Provider Business Practice Location Address
First Line	:	2 S COO Y YAH ST
Second Line	:	SUITE 4
City	:	PRYOR
State	:	OK
Zip	:	74361-4636
Country	:	US
Telephone Number	:	918-756-9411
Fax Number	:	918-756-2126

Authorized Official
Title or Position	:	VP OF CLINICAL SERVICES
Name	:	MR. CHRIS M PERRY
Credential	:	LPC
Telephone Number	:	918-756-9411

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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Directions to “CREOKS MENTAL HEALTH SERVICES ” Practice Location

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