Provider Demographics
NPI:1801295464
Name:MENTAL HEALTH SERVICE OF SOUTHERN OKLAHOMA
Entity type:Organization
Organization Name:MENTAL HEALTH SERVICE OF SOUTHERN OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECOVERY SUPPORT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-924-7331
Mailing Address - Street 1:1001 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5038
Mailing Address - Country:US
Mailing Address - Phone:580-924-7330
Mailing Address - Fax:580-924-2739
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5038
Practice Address - Country:US
Practice Address - Phone:580-924-7330
Practice Address - Fax:580-924-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable