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Organization
PROVIDENCE SERVICE CORP
Active
Organization
PROVIDENCE SERVICE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA A MYERS BA, PSRS (REHAB SPECIALIST)
(580) 326-7477
Entity
Organization
Contact information
Practice address
117 E MAIN ST, HUGO, OK 74743-6237
(580) 326-7477
(580) 326-6400
Mailing address
117 E MAIN ST, HUGO, OK 74743-6237
(580) 326-7477
(580) 326-6400
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100750190
—
OK
Enumeration date
03/18/2011
Last updated
03/18/2011
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