MEDICARE: OKLAHOMA MENTAL HEALTH COUNCIL

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

General Provider Information

NPI Number	:	1811283492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA MENTAL HEALTH COUNCIL

Provider Business Mailing Address
First Line	:	4400 N LINCOLN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-5104
Country	:	US
Telephone Number	:	405-424-7711
Fax Number	:	405-425-0343

Provider Business Practice Location Address
First Line	:	2245 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8831
Country	:	US
Telephone Number	:	405-425-0442
Fax Number	:	405-425-0343

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ALLYN S FRIEDMAN
Credential	:	M.A.
Telephone Number	:	405-424-7711

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/22/2011

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