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
323 W. 6TH STREET, OKMULGEE, OK 74447
(918) 756-9250
(918) 756-2126
Mailing address
4103 S YALE AVE STE B, TULSA, OK 74135-6002
(918) 382-7300
(918) 382-7302
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
100734620G
OK
251S00000X
Community/Behavioral Health Agency
Primary
100734620A
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734620A
—
OK
05
—
100734620G
—
OK
Enumeration date
04/09/2007
Last updated
10/15/2019
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