| NPI | 1730935610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY D SMITH Credentialing/Contracting Agent 405-984-7174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-04-30 |