| State Of Oklahoma | |
|
1222 10th Street, Suite 211 Northwest Center For Behavioral Health Woodward OK 73801-3156 | |
| (580) 571-3217 | |
| (580) 256-8609 |
| Full Name | State Of Oklahoma |
|---|---|
| Speciality | Clinic/center - Medical Specialty |
| Location | 1222 10th Street, Suite 211, Woodward, Oklahoma |
| Authorized Official Name and Position | Autumn Nickelson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5805713231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Oklahoma 1222 10th Street, Suite 211 Northwest Center For Behavioral Health Woodward OK 73801-3156 Ph: (580) 571-3217 | State Of Oklahoma 1222 10th Street, Suite 211 Northwest Center For Behavioral Health Woodward OK 73801-3156 Ph: (580) 571-3217 |
| NPI Number | 1750456588 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 03/24/2022 |
| Certification Date | 03/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750456588 | NPI | - | NPPES |
| 100707390A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
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