1659610368 NPI number — DEPRESSION BIPOLAR SUPPORT ALLIANCE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659610368 NPI number — DEPRESSION BIPOLAR SUPPORT ALLIANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPRESSION BIPOLAR SUPPORT ALLIANCE
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:
DBSA
Provider Other Organization Name Type Code:
5
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:
1659610368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8601 NW 106TH ST
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:
73162-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
405-722-0612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 UNITED FOUNDERS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-413-7778
Provider Business Practice Location Address Fax Number:
405-722-0612
Provider Enumeration Date:
02/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CROOKS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
EXCECUTIVE DIRECTOR OF DBSA
Authorized Official Telephone Number:
405-413-7778

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)





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