1649688391 NPI number — OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC

Table of content: DAWN L. MIN LCSW (NPI 1912075821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649688391 NPI number — OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC
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:
1649688391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 RENNER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-692-7839
Provider Business Mailing Address Fax Number:
972-792-6739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302B SW LEE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501-5610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-355-1870
Provider Business Practice Location Address Fax Number:
580-355-1877
Provider Enumeration Date:
07/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE LEGAL MANAGER
Authorized Official Telephone Number:
512-692-7839

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HC8071 . This is a "OKLAHOMA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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