Organization
WAYNOKA MENTAL HEALTH AUTHORITY
Active
Other names
Northwest Substance Abuse Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIDNEY DON SMILEY MED IN COUNSELING (CHAIRMAN OF THE TRUSTEE BOARD)
(580) 824-0674
Entity
Organization
Contact information
Practice address
1095 NICKERSON ST, WAYNOKA, OK 73860-1252
(580) 824-0674
(580) 824-0676
Mailing address
PO BOX 135, WAYNOKA, OK 73860-0135
(580) 824-0674
(580) 824-0676
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
76244
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54197143
TPIN NUMBER
OK
Enumeration date
03/15/2007
Last updated
08/22/2020
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