# PROVIDENCE SERVICE CORPORATION

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

## Provider details

- **NPI number:** 1821003658
- **Authorized official:** MS. AGLAIA 'ALEXIS' MARTIN LPC (THERAPIST)
- **Authorized official phone:** (580) 355-6800

## Contact information

- **Practice address:** 4645 W GORE BLVD, SUITE 5, LAWTON, OK 73505-6041
- **Practice address phone:** (580) 355-6800
- **Mailing address:** 4645 W GORE BLVD, SUITE 5, LAWTON, OK 73505-6041
- **Mailing address phone:** (580) 355-6800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 2560 | OK | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 08/22/2020