Provider Demographics
NPI:1487076550
Name:MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Entity type:Organization
Organization Name:MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-223-5070
Mailing Address - Street 1:9432 N MAY AVE
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2716
Mailing Address - Country:US
Mailing Address - Phone:405-608-8030
Mailing Address - Fax:
Practice Address - Street 1:9432 N MAY AVE
Practice Address - Street 2:SUITE D-2
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2716
Practice Address - Country:US
Practice Address - Phone:405-608-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100728830Medicaid
OKMHSSWMedicare PIN