| NPI | 1194579474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS JOSLIN Credentialing Manager 918-766-8217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |