Organization
ODMHSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINQUE M LEE (RSS)
(918) 915-0309
Entity
Organization
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
Mailing address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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