| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 91 Broadlawn, Ardmore, Oklahoma |
| Authorized Official Name and Position | Robert E Lee (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5802335070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 189 Ardmore OK 73402-0189 Ph: (580) 223-5070 | 91 Broadlawn Ardmore OK 73401 Ph: (580) 223-5070 |
| NPI Number | 1144404252 |
|---|---|
| Provider Enumeration Date | 12/26/2007 |
| Last Update Date | 12/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144404252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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