| NPI | 1447657929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MICHAEL KISSICK Director 405-340-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 4707) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2014-11-26 |