Provider Demographics
NPI:1902141765
Name:CATALYST HEALTH CLINIC L.L.C.
Entity Type:Organization
Organization Name:CATALYST HEALTH CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-230-1142
Mailing Address - Street 1:3033 N WALNUT AVE
Mailing Address - Street 2:WEST BUILDING
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2832
Mailing Address - Country:US
Mailing Address - Phone:405-751-9679
Mailing Address - Fax:405-557-0801
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-751-9679
Practice Address - Fax:405-557-0801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATALYST BEHAVIORAL SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty