Provider Demographics
NPI:1407067879
Name:MENTAL HEALTH RESOURCES CORP.
Entity type:Organization
Organization Name:MENTAL HEALTH RESOURCES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-210-7851
Mailing Address - Street 1:416 W 15TH ST
Mailing Address - Street 2:BUILDING 500, SUITE E
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-726-2745
Mailing Address - Fax:405-726-2746
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:BUILDING 500, SUITE E
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-726-2745
Practice Address - Fax:405-726-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK846261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK550765856001Medicare UPIN
OK300522113Medicare ID - Type Unspecified