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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. KIMBERLY SHOALS (CLINICAL DIRECTOR)
(405) 272-1610
Entity
Organization

Contact information

Practice address
214 SW 30TH ST, OKLAHOMA CITY, OK 73109-6506
(405) 272-1610
(405) 272-1630
Mailing address
214 SW 30TH ST, OKLAHOMA CITY, OK 73109-6506
(405) 272-1610
(405) 272-1630

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OK

Other

Enumeration date
05/05/2010
Last updated
05/05/2010
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