Provider Demographics
NPI:1861966814
Name:POSITIVE OUTCOMES THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:POSITIVE OUTCOMES THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PELLEBON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:405-255-8503
Mailing Address - Street 1:2227 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6520
Mailing Address - Country:US
Mailing Address - Phone:405-255-8503
Mailing Address - Fax:405-857-1678
Practice Address - Street 1:2500 BOARDWALK STE 210
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6593
Practice Address - Country:US
Practice Address - Phone:405-857-8357
Practice Address - Fax:405-857-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-13
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty