| NPI | 1063624351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE JAMES MADDOX Adolescent Program Director 405-810-1766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: 291) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |