Organization
GREEN COUNTRY BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA DEASON L.P.C. L.B.P. (CLINICAL DIRECTOR)
(918) 682-8407
Entity
Organization
Contact information
Practice address
619 N MAIN ST, MUSKOGEE, OK 74401-4431
(918) 682-8407
(918) 687-0976
Mailing address
619 N MAIN ST, MUSKOGEE, OK 74401-4431
(918) 682-8407
(918) 687-0976
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YM0800X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734050
—
OK
Enumeration date
02/03/2010
Last updated
02/03/2010
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