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1215 Nw 25th St Oklahoma City OK 73106 | |
| (405) 525-2525 | |
| (405) 524-3549 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1215 Nw 25th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Marc A Noto (COO) |
| Authorized Official Contact | 4055252525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1215 Nw 25th St Oklahoma City OK 73106-5629 Ph: (405) 525-2525 | 1215 Nw 25th St Oklahoma City OK 73106 Ph: (405) 525-2525 |
| NPI Number | 1083089122 |
|---|---|
| Provider Enumeration Date | 12/01/2015 |
| Last Update Date | 07/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083089122 | NPI | - | NPPES |
| 200079780B | Medicaid | OK | |
| 200079780 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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