1558505701 NPI number — OKLAHOMA MENTAL HEALTH COUNCIL

Table of content: (NPI 1558505701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558505701 NPI number — OKLAHOMA MENTAL HEALTH COUNCIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA MENTAL HEALTH COUNCIL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558505701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 N LINCOLN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73105-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-425-0428
Provider Business Mailing Address Fax Number:
405-419-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 WEST COMMERCE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUKON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-354-1927
Provider Business Practice Location Address Fax Number:
405-354-3927
Provider Enumeration Date:
04/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FOUST
Authorized Official First Name:
VERNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-424-7711

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100635250R , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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