Organization
STATE OF OKLAHOMA; DBA:BILL WILLIS COMMUNITY MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER MICHAEL KINNEY DPH (DIRECTOR OF PHARMACY)
(918) 207-3049
Entity
Organization
Contact information
Practice address
1400 S. HENSLEY DR, TAHLEQUAH, OK 74465-0558
(918) 207-3049
(918) 207-3065
Mailing address
1400 S. HENSLEY DR, P.O. BOX 558, TAHLEQUAH, OK 74465-0558
(918) 207-3049
(918) 207-3065
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
36-4537
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29393
STATE BNDD CONTROL NUMBER
OK
01
—
364537
STATE BOARD OF PHARMACY L
OK
Enumeration date
04/03/2007
Last updated
03/07/2023
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