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Organization

RISE PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GARY P NELSON MS,LPC,LADC (CEO/OWNER)
(918) 448-0590
Entity
Organization

Contact information

Practice address
311 W MAIN ST, WILBURTON, OK 74578-4047
(918) 465-0909
(918) 465-0404
Mailing address
311 W MAIN ST, WILBURTON, OK 74578-4047
(918) 465-0909
(918) 465-0404

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
OK
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
N/A
OK
Enumeration date
12/03/2012
Last updated
12/03/2012
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