| NPI | 1548895931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JEAN WICKSTROM Executive Director 405-290-7322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-06 |