Provider Demographics
NPI:1336731983
Name:ALLIANCE MENTAL HEALTH, LLC.
Entity type:Organization
Organization Name:ALLIANCE MENTAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-608-0380
Mailing Address - Street 1:PO BOX 521147
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-1147
Mailing Address - Country:US
Mailing Address - Phone:918-608-0380
Mailing Address - Fax:
Practice Address - Street 1:116 S WASHINGTON ST STE 7
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5612
Practice Address - Country:US
Practice Address - Phone:918-608-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE MENTAL HEALTH, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500089930Medicaid