Organization
EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER INC.
Active
Organization
EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY HOMER COWAN LPC (EXECUTIVE DIRECTOR)
(580) 762-7561
Entity
Organization
Contact information
Practice address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 762-7561
(580) 762-2576
Mailing address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 762-7561
(580) 762-2576
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100749540K
—
OK
05
—
100749540M
—
OK
05
—
100749540O
—
OK
Enumeration date
11/14/2006
Last updated
06/16/2008
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