| Edwin Fair Cmhc | |
|
201 E Chestnut Ave Ponca City OK 74601-4311 | |
| (580) 762-7561 | |
| (580) 762-2576 |
| Full Name | Edwin Fair Cmhc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 201 E Chestnut Ave, Ponca City, Oklahoma |
| Authorized Official Name and Position | Misty Dawn Daniels (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5807627561 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edwin Fair Cmhc 1500 N 6th St Ponca City OK 74601-2827 Ph: (580) 762-7561 | Edwin Fair Cmhc 201 E Chestnut Ave Ponca City OK 74601-4311 Ph: (580) 762-7561 |
| NPI Number | 1972764736 |
|---|---|
| Provider Enumeration Date | 06/24/2008 |
| Last Update Date | 10/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972764736 | NPI | - | NPPES |
| 100749540E | Medicaid | OK | |
| 100749540T | Medicaid | OK | |
| 100749540X | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Edwin Fair Community Mental Health Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 N 5th St, Ponca City, OK 74601 Phone: 580-762-7561 Fax: 580-762-2576 | |
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Laura Peitz Counseling Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1912 Lake Rd, Ponca City, OK 74604 Phone: 580-762-6511 Fax: 580-762-6511 | |
Edwin Fair Community Mental Health Center Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 N 6th St, Ponca City, OK 74601 Phone: 580-762-7561 Fax: 580-762-2576 | |
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