Provider Demographics
NPI:1427311687
Name:CREOKS BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:CREOKS BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHRS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC CANDIDATE
Authorized Official - Phone:620-404-8981
Mailing Address - Street 1:426 W LOS ANGELES PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-4835
Mailing Address - Country:US
Mailing Address - Phone:620-404-8981
Mailing Address - Fax:
Practice Address - Street 1:426 W LOS ANGELES PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-4835
Practice Address - Country:US
Practice Address - Phone:620-404-8981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25103TC1900X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health