# NORTHEASTERN HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689338519
- **Authorized official:** JACKIE HULLINGER (VP OF REVENUE CYCLE)
- **Authorized official phone:** (918) 458-2417

## Contact information

- **Practice address:** 1323 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3462
- **Practice address phone:** (918) 506-6901
- **Mailing address:** PO BOX 1008, TAHLEQUAH, OK 74465-1008
- **Mailing address phone:** (918) 458-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2021
- **Last updated:** 11/07/2024