MEDICARE: SEASONS OF CHANGE BEHAVIORAL HEALTH SERVICES, INC.

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	5267	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	:	1821405770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS OF CHANGE BEHAVIORAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	409 S FRETZ AVE
Second Line	:	SUITE C
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	405-726-9808
Fax Number	:	405-726-9809

Provider Business Practice Location Address
First Line	:	409 S FRETZ AVE
Second Line	:	SUITE C
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	405-726-9808
Fax Number	:	405-726-9809

Authorized Official
Title or Position	:	CEO
Name	:	LORIEN OLIVIA HOLMAN
Credential	:	LPC
Telephone Number	:	405-726-9808

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	09/01/2016

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