Organization
CREOKS MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT M. BLACK LPC (EXECUTIVE DIRECTOR)
(918) 756-9411
Entity
Organization
Contact information
Practice address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
(918) 207-0558
Mailing address
4103 S YALE AVE STE B, TULSA, OK 74135-6002
(918) 382-7300
(918) 382-7302
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
100734620L
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734620L
—
OK
Enumeration date
04/03/2007
Last updated
10/15/2019
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