Organization
CREOKS
Active
Organization
CREOKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN TITSWORTH (IPS)
(918) 623-8673
Entity
Organization
Contact information
Practice address
209 W BROADWAY ST, OKEMAH, OK 74859-2618
(918) 623-8673
Mailing address
4103 S YALE AVE, TULSA, OK 74135-6002
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/09/2021
Last updated
08/16/2021
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