Organization
CREOKS MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT M BLACK LPC (EXECUTIVE DIRECTOR)
(918) 756-9411
Entity
Organization
Contact information
Practice address
209 W. BROADWAY, OKEMAH, OK 74859
(918) 623-2922
(918) 756-2126
Mailing address
P.O. BOX 760, OKMULGEE, OK 74447
(918) 756-9411
(918) 756-2126
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
100734620G
OK
251S00000X
Community/Behavioral Health Agency
Primary
100734620D
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734620D
—
OK
05
—
100734620G
—
OK
Enumeration date
04/11/2007
Last updated
10/15/2019
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