| NPI | 1023411907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP LANE BENNETT Counselor 405-712-0514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 2291) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-08 |