Organization
EAGLE RIDGE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM CLARK LPC (AREA PROGRAM DIRECTOR)
(918) 485-3554
Entity
Organization
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-3554
(918) 485-8371
Mailing address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-3554
(918) 485-8371
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/16/2007
Last updated
08/22/2020
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