Provider Demographics
NPI:1902671324
Name:HOMETEAM BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:HOMETEAM BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:559-355-6882
Mailing Address - Street 1:3309 W 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2251
Mailing Address - Country:US
Mailing Address - Phone:559-355-6882
Mailing Address - Fax:
Practice Address - Street 1:406 E HALL OF FAME AVE STE 250
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5436
Practice Address - Country:US
Practice Address - Phone:918-216-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201216170CMedicaid
OK201216170AMedicaid
OK201216170BMedicaid