Organization
NORTHEASTERN HEALTH SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE HULLINGER (VP OF REVENUE CYCLE)
(918) 458-2417
Entity
Organization
Contact information
Practice address
1323 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3462
(918) 506-6901
Mailing address
PO BOX 1008, TAHLEQUAH, OK 74465-1008
(918) 458-2111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/27/2021
Last updated
11/07/2024
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