| Counseling Center Of Se Oklahoma | |
|
100 N Broadway St Broken Bow OK 74728-3934 | |
| (580) 584-6054 | |
| Not Available |
| Full Name | Counseling Center Of Se Oklahoma |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 100 N Broadway St, Broken Bow, Oklahoma |
| Authorized Official Name and Position | Derrel Levy (EXEC DIR) |
| Authorized Official Contact | 5802982830 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Counseling Center Of Se Oklahoma 4207 E Highway 290 Dripping Springs TX 78620-4206 Ph: () - | Counseling Center Of Se Oklahoma 100 N Broadway St Broken Bow OK 74728-3934 Ph: (580) 584-6054 |
| NPI Number | 1699838565 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 11/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699838565 | NPI | - | NPPES |
| 100744370D | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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