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Organization

CANADIAN COUNTY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JOAN SOUTH LBP (FACILITY DIRECTOR)
(405) 262-0202
Entity
Organization

Contact information

Practice address
7905 EAST HIGHWAY 66, EL RENO, OK 73036
(405) 262-0202
(405) 262-0259
Mailing address
7905 EAST HIGHWAY 66, EL RENO, OK 73036
(405) 262-0202
(405) 262-0259

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
K850000246
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2000727780
OK
Enumeration date
04/27/2007
Last updated
06/20/2008
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