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107 S High St Antlers OK 74523-3818 | |
| (580) 298-2830 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 S High St, Antlers, Oklahoma |
| Authorized Official Name and Position | Dorothy Mckinnon (EXEC DIR) |
| Authorized Official Contact | 5802982830 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1030 Antlers OK 74523-1030 Ph: (580) 298-2830 | 107 S High St Antlers OK 74523-3818 Ph: (580) 298-2830 |
| NPI Number | 1063576122 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 06/28/2024 |
| Certification Date | 06/28/2024 |
| Medicare PECOS PAC ID | 5294031167 |
|---|---|
| Medicare Enrollment ID | O20240819004343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063576122 | NPI | - | NPPES |
| 100744370P | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dorothy Mckinnon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225258999 PECOS PAC ID: 2466758339 Enrollment ID: I20240914000768 |
| Provider Name | Denise Shipman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356546667 PECOS PAC ID: 4789125865 Enrollment ID: I20240916003964 |
| Provider Name | Tara Martin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922421098 PECOS PAC ID: 3971044959 Enrollment ID: I20240917004778 |
| Provider Name | Johnette R Stites |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093126195 PECOS PAC ID: 1557802030 Enrollment ID: I20240924003425 |
| Provider Name | Amanda Mckitrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154839892 PECOS PAC ID: 8628500238 Enrollment ID: I20241021000102 |
| Provider Name | Kristianna Carswell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801086236 PECOS PAC ID: 5799217303 Enrollment ID: I20241021000204 |
| Provider Name | Vince Maytubby |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295992261 PECOS PAC ID: 4486187994 Enrollment ID: I20241023000061 |
| Provider Name | Tammy Bower |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902160179 PECOS PAC ID: 8921531443 Enrollment ID: I20241023000142 |
| Provider Name | Dana Grace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700105541 PECOS PAC ID: 8820521347 Enrollment ID: I20241023000193 |
| Provider Name | Janice I Lunsford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922292127 PECOS PAC ID: 8729512868 Enrollment ID: I20241112001061 |
| Provider Name | Natalie R Stuart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154088599 PECOS PAC ID: 6002341229 Enrollment ID: I20241125004403 |
Quest Mhsa, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 905 W Main St, Antlers, OK 74523 Phone: 580-298-3001 | |
Brighter Heights Oklahoma, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 S High St, Antlers, OK 74523 Phone: 580-298-2830 | |
Brighter Heights Oklahoma, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 S High St, Antlers, OK 74523 Phone: 580-298-2830 | |
Crossroads 1010 Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 193908 Us Hwy 271, Antlers, OK 74523 Phone: 580-271-7080 Fax: 580-298-2081 |