Provider Demographics
NPI:1841451309
Name:OSAGE NATION COUNSELING CENTER
Entity type:Organization
Organization Name:OSAGE NATION COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-287-9744
Mailing Address - Street 1:606 KIHEKAH
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-4201
Mailing Address - Country:US
Mailing Address - Phone:918-287-5414
Mailing Address - Fax:918-287-5234
Practice Address - Street 1:606 KIHEKAH
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-4201
Practice Address - Country:US
Practice Address - Phone:918-287-5414
Practice Address - Fax:918-287-5234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSAGE NATION COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-18
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK197101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty