Provider Demographics
NPI:1538550629
Name:OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE
Entity type:Organization
Organization Name:OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSUMER RECOVERY SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CICELY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-2300
Mailing Address - Street 1:2625 GENERAL PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6437
Mailing Address - Country:US
Mailing Address - Phone:405-942-2300
Mailing Address - Fax:405-942-2303
Practice Address - Street 1:2625 GENERAL PERSHING BOULEVARD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-942-2300
Practice Address - Fax:405-942-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management