Organization
EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFF COWAN LPC (EXECUTIVE DIRECTOR)
(580) 761-5608
Entity
Organization
Contact information
Practice address
201 E CHESTNUT AVE, PONCA CITY, OK 74601-4311
(580) 763-0931
Mailing address
3542 SPRINGWOOD ST APT 604, PONCA CITY, OK 74604-1632
(580) 716-1731
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
171M00000X
OK
251B00000X
Case Management Agency
Primary
—
OK
Other
Enumeration date
03/28/2007
Last updated
08/22/2020
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