Organization
MODOC TRIBE OF OKLAHOMA
Active
Other names
Lost River Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
LACI BARTON APRN-CNP (DIRECTOR OF OPERATIONS)
(918) 303-5433
Entity
Organization
Contact information
Practice address
10025 S 705 RD, WYANDOTTE, OK 74370-9507
(918) 303-5433
Mailing address
22 N EIGHT TRIBES TRL, MIAMI, OK 74354-1011
(918) 542-1190
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
04/14/2026
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