PROVIDENCE SERVICE CORPORATION OF OKLAHOMA (NPI# 1033279443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033279443 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE SERVICE CORPORATION OF OKLAHOMA |
| Other Organization Name | PROVIDENCE OF OKLAHOMA |
| Practice Address |
4645 W Gore Blvd Ste 5 Lawton OK 73505-5962 |
| Mailing Address |
620 N Craycroft Rd Tucson AZ 85711-1448 |
| Practice Telephone | 5803556800 |
| Practice Fax Number | 5803550666 |
| Mailing Telephone | 5207476600 |
| Mailing Fax Number | 5207476613 |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | BREEANN MARIE HOERNING (AR AND BILLING MANAGER) |
| Authorized Official Telephone | 5207476600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Providence of Oklahoma | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740340157 | Providence Service Corporation of Oklahoma | Clinic/Center | 105 Plaza, Madill, OK 73446-2248 | 2006-12-08 |
| 1639239023 | Providence Service Corporation of Oklahoma | Clinic/Center | 301 N High St, Antlers, OK 74523-2238 | 2006-12-08 |
| 1407916802 | Providence Service Corporation of Oklahoma | Clinic/Center | 134 N 12th Ave, Durant, OK 74701-4718 | 2006-12-08 |
| 1487726170 | Providence Service Corporation of Oklahoma | Clinic/Center | 931 Arlington St Ste 2, Ada, OK 74820-4025 | 2006-11-15 |
| 1295154581 | Providence Service Corporation of Oklahoma | Community/Behavioral Health | 116 Se Ave N, Idabel, OK 74745-5234 | 2014-04-15 |
| 1568504553 | Providence Service Corporation of Oklahoma | Case Management | 134 N 12th Ave, Durant, OK 74701-4718 | 2007-02-13 |
| 1003958091 | Providence Service Corporation of Oklahoma | Case Management | 134 N 12th Ave, Durant, OK 74701-4718 | 2007-02-13 |
| 1811039894 | Providence Service Corporation of Oklahoma | Case Management | 931 Arlington St Ste 2, Ada, OK 74820-4025 | 2007-02-13 |
| 1942342944 | Providence Service Corporation of Oklahoma | Case Management | 105 Plaza, Madill, OK 73446-2248 | 2007-02-13 |
| 1184766172 | Providence Service Corporation of Oklahoma | Case Management | 117 E Main St, Hugo, OK 74743-6237 | 2007-02-13 |
| Street Address |
4645 W GORE BLVD STE 5 |
| City | LAWTON |
| State | OK |
| Zip Code | 73505-5962 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699817692 | Providence Service Corporation of Oklahoma | Case Management | 4645 W Gore Blvd Ste 5, Lawton, OK 73505-5962 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134744006 | Angela Janell Smith | Case Manager/Care Coordinator | 4904 Nw Smith Ave, Lawton, OK 73505 | 2020-06-16 |
| 1295383990 | Akeemia Lorene Holder | Case Manager/Care Coordinator | Youth Care of Oklahoma, 713 Sw C Avenue, OK 73505 | 2019-08-27 |
| 1225685480 | Healthstat Onsite Clinic Goodyear Vision Center | Preventive Medicine | 1 Goodyear Blvd, Lawton, OK 73505 | 2019-08-22 |
| 1891285300 | Michael Anthony Gray | Case Manager/Care Coordinator | 2218 Nw 36th St, Lawton, OK 73505 | 2018-05-10 |
| 1841797362 | Adeshola T Fatuyi | Case Manager/Care Coordinator | 7301 Sw Lee 635, Lawton, OK 73505 | 2018-04-11 |
| 1912425539 | Heather Shea Morefield | Case Manager/Care Coordinator | 2712 Sw H Ave, Lawton, OK 73505 | 2017-09-04 |
| 1972031367 | Burke Hendricks | Emergency Medicine | 3401 West Gore Boulevard, Lawton, OH 73505 | 2017-05-30 |
| 1932642279 | Helery Vance | Peer Specialist | 1420 Nw Hunter Rd Apt C7, Lawton, OK 73505 | 2016-11-18 |
| 1629523436 | Sebrina Sheppard | Case Manager/Care Coordinator | 3907 Sw Parkridge Blvd., Lawton, OK 73505 | 2016-08-22 |
| 1376913590 | David Lee Atauvich | Registered Nurse | 1515 Lawrie Rd, Lawton, OK 73505 | 2015-09-30 |
| Find all providers in zip 73505 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303721 | Misty Watkins | Clinic/Center | 1601 Sw Parkridge Blvd Ste 200, Lawton, OK 73505-7564 | 2020-10-14 |
| 1487289252 | Compass Counseling Services, LLC | Clinic/Center | 305 Tara Way, Lawton, IA 51030-1026 | 2020-03-11 |
| 1346750569 | The Mind, Heart & Soul Counseling Enrichment Organization, LLC | Clinic/Center | 1317 Sw Washington Ave, Lawton, OK 73501-7231 | 2017-10-02 |
| 1568027118 | Powers & Powers, Inc | Clinic/Center | 1930 Nw Ferris Ave Ste 4, Lawton, OK 73507-5629 | 2019-05-08 |
| 1194241240 | Mistie Lynn Farmer | Clinic/Center | 602 Sw 38th St, Lawton, OK 73505-6912 | 2017-08-21 |
| 1154877561 | Anthony Mans | Clinic/Center | 808 Nw 35th St, Lawton, OK 73505-5120 | 2016-08-27 |
| 1629400288 | Yco Tulsa, Inc. | Clinic/Center | 602 Sw A Ave, Lawton, OK 73501-3930 | 2013-08-06 |
| 1417059460 | Christian Family Counseling Center Inc | Clinic/Center | 5002 Sw Lee Blvd, Lawton, OK 73505 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870742 | Sequelcare of Oklahoma, LLC | Clinic/Center | 6218 S Lewis Ave Ste 118, Tulsa, OK 74136-1018 | 2020-10-28 |
| 1649870890 | M & M Counseling Group, LLC | Clinic/Center | 207 S Czech Hall Rd, Yukon, OK 73099-6851 | 2020-10-27 |
| 1295342046 | Integrative Healthcare Solutions LLC | Clinic/Center | 2227 E 8th St, Tulsa, OK 74104-3237 | 2020-09-25 |
| 1235744020 | Strength of A Warrior Counseling Services LLC | Clinic/Center | 4516 Se 25th St, Del City, OK 73115-4114 | 2020-09-09 |
| 1609488253 | Alexie Foster, LLC | Clinic/Center | 16802 S 301st West Ave, Bristow, OK 74010-2265 | 2020-08-17 |
| 1306455068 | Restore Family Counseling, LLC | Clinic/Center | 100 W. Wilshire, Suite #c3, Oklahoma City, OK 73116 | 2020-07-29 |
| 1245855857 | Dragonfly Psychotherapy | Clinic/Center | 2942 Ne Orlie Dr, Forest Park, OK 73121-2436 | 2020-06-09 |
| 1508480872 | Maria Nancy Martinez | Clinic/Center | 5350 S Western Ave Ste 217, Oklahoma City, OK 73109-4525 | 2020-06-03 |
| 1649894015 | Miranda Rackers | Clinic/Center | 1308 E Mckinley Ave, Sapulpa, OK 74066-4824 | 2020-06-02 |
| 1144842923 | Forth Star Counseling LLC | Clinic/Center | 5350 S Western Ave Ste 731, Oklahoma City, OK 73109-4520 | 2020-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.