Organization
REDEFINE U
Active
Organization
REDEFINE U
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLEY L COOK MHR/LADC # 624 (CO-OWNER/DIRECTOR)
(918) 431-0634
Entity
Organization
Contact information
Practice address
2511 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5459
(918) 431-0634
(908) 431-0654
Mailing address
2511 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5459
(918) 431-0634
(908) 431-0654
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/21/2009
Last updated
09/21/2009
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