Organization
SPECIALIZED OUTPATIENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE JAMES MADDOX CADC (ADOLESCENT PROGRAM DIRECTOR)
(405) 810-1766
Entity
Organization
Contact information
Practice address
5208 CLASSEN CIR, OKLAHOMA CITY, OK 73118-4429
(405) 810-1766
(405) 810-0331
Mailing address
5208 CLASSEN CIR, OKLAHOMA CITY, OK 73118-4429
(405) 810-1766
(405) 810-0331
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
291
—
Other
Enumeration date
05/07/2007
Last updated
08/22/2020
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