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1000 N Lee Ave Oklahoma City OK 73102-1036 | |
| (405) 272-6216 | |
| (405) 272-6927 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1000 N Lee Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Crystal L Pena (INSURANCE CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4052727452 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 269009 Oklahoma City OK 73126-9009 Ph: () - | 1000 N Lee Ave Oklahoma City OK 73102-1036 Ph: (405) 272-6216 |
| NPI Number | 1336235159 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 03/25/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336235159 | NPI | - | NPPES |
| 100728880 O | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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