| Family Development And Intervention Services | |
|
5131 N Classen Blvd Suite 110 Oklahoma City OK 73118-5258 | |
| (405) 767-1126 | |
| (405) 767-6285 |
| Full Name | Family Development And Intervention Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5131 N Classen Blvd, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Wesley Cornell Long (PRESIDENT) |
| Authorized Official Contact | 4057671126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Development And Intervention Services 5131 N Classen Blvd Suite 110 Oklahoma City OK 73118-5258 Ph: (405) 767-1126 | Family Development And Intervention Services 5131 N Classen Blvd Suite 110 Oklahoma City OK 73118-5258 Ph: (405) 767-1126 |
| NPI Number | 1588723548 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6608264601 |
|---|---|
| Medicare Enrollment ID | O20211025001453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588723548 | NPI | - | NPPES |
| 200094410A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 261QM0801X (Oklahoma) | Primary |
| Provider Name | Kathryn L Olsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629601240 PECOS PAC ID: 3678904836 Enrollment ID: I20200504001749 |
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