| NPI | 1639537970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLINDA RENEE FANJ Mental Health Professional 918-869-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OK 4921) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2016-02-01 |