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211 N Hwy 10 Ste D Kansas OK 74347-7607 | |
| (918) 308-5518 | |
| (918) 999-0112 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 211 N Hwy 10 Ste D, Kansas, Oklahoma |
| Authorized Official Name and Position | Larry Smith (CEO) |
| Authorized Official Contact | 9182731841 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
114 W Delaware Ave Nowata OK 74048-2601 Ph: (918) 273-1841 | 211 N Hwy 10 Ste D Kansas OK 74347-7607 Ph: (918) 308-5518 |
| NPI Number | 1932749876 |
|---|---|
| Provider Enumeration Date | 01/08/2020 |
| Last Update Date | 06/15/2022 |
| Certification Date | 06/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932749876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |