Provider Demographics
NPI:1568004232
Name:CREOKS MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:CREOKS MENTAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GH HELP DESK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-382-7300
Mailing Address - Street 1:4103 S YALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6002
Mailing Address - Country:US
Mailing Address - Phone:918-495-4128
Mailing Address - Fax:918-281-8033
Practice Address - Street 1:4103 S YALE AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6002
Practice Address - Country:US
Practice Address - Phone:918-495-4128
Practice Address - Fax:918-281-8033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREOKS MENTAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-14
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200751200CMedicaid