| NPI | 1265185664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH DUTY Controller 918-392-5811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-01-27 |