CREOKS MENTAL HEALTH SERVICES (NPI# 1043331499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043331499 |
| Entity Type | Organization |
| Organization Name | CREOKS MENTAL HEALTH SERVICES |
| Practice Address |
711 S Muskogee Ave Tahlequah OK 74464-4717 |
| Mailing Address |
4103 S Yale Ave Ste B Tulsa OK 74135-6002 |
| Practice Telephone | 9182070078 |
| Practice Fax Number | 9182070558 |
| Mailing Telephone | 9183827300 |
| Mailing Fax Number | 9183827302 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2019-10-15 |
| Authorized Official Name | MR. BRENT M. BLACK (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9187569411 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 100734620L | OK | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100734620L | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730712316 | Creoks Mental Health Services | Clinic/Center | 19320 E Admiral Pl Ste B, Catoosa, OK 74015-3240 | 2020-02-21 |
| 1528603198 | Creoks Mental Health Services | Clinic/Center | 186 W Court St, Atoka, OK 74525-1822 | 2019-11-07 |
| 1689219263 | Creoks Mental Health Services | Community/Behavioral Health | 2807 N Broadway St Ste C, Poteau, OK 74953-5557 | 2019-11-07 |
| 1699310276 | Creoks Mental Health Services | Community/Behavioral Health | 4704 Nw Motif Manor Blvd Ste 4, Lawton, OK 73505-4800 | 2019-11-07 |
| 1598316358 | Creoks Mental Health Services | Clinic/Center | 2548 E Kenosha St, Broken Arrow, OK 74014-6712 | 2019-09-24 |
| 1225333826 | Creoks Mental Health Services | Community/Behavioral Health | 716 S 2nd St Ste 101, Stilwell, OK 74960-4806 | 2011-01-13 |
| 1841311289 | Creoks Mental Health Services | Community/Behavioral Health | 4103 S Yale Ave Ste B, Tulsa, OK 74135-6002 | 2007-04-03 |
| 1568004232 | Creoks Mental Health Services | Pharmacy | 4103 S Yale Ave Ste B, Tulsa, OK 74135-6002 | 2019-10-14 |
| 1104360692 | Creoks Mental Health Services | Community/Behavioral Health | 203 2nd Ave Sw, Miami, OK 74354-6818 | 2016-12-19 |
| 1700136900 | Creoks Mental Health Services | Community/Behavioral Health | 2 S Coo Y Yah St, Suite 4, Pryor, OK 74361-4636 | 2012-09-14 |
| Street Address |
711 S MUSKOGEE AVE |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-4717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902403702 | Millissa Kae Robinson | Peer Specialist | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2020-10-05 |
| 1154947919 | Jennifer Ann Ruppel | Case Manager/Care Coordinator | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2020-06-17 |
| 1982238457 | Dawn Johnson | Counselor | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2020-02-24 |
| 1043850829 | Corey A Thornton | Counselor | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2020-01-09 |
| 1336785211 | Cortnie Cox | Case Manager/Care Coordinator | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2019-11-26 |
| 1851940324 | Christian Denell Riley | Behavioral Analyst | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2019-09-08 |
| 1134776008 | Martha J Smith | Registered Nurse | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2019-08-24 |
| 1700349883 | Heather Marie Askew | Peer Specialist | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2019-04-07 |
| 1124589395 | Ashlee Kay Morton | Case Manager/Care Coordinator | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2019-03-28 |
| 1477026995 | Regina Page | Counselor | 711 S Muskogee Ave, Tahlequah, OK 74464-4717 | 2019-01-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407477920 | Keetoowah Economic Development | Community/Behavioral Health | 16414 W 760 Rd, Tahlequah, OK 74464-1675 | 2020-05-06 |
| 1982061115 | Rise Center for Recovery | Community/Behavioral Health | 223 N East Ave, Tahlequah, OK 74464-3249 | 2016-01-19 |
| 1922483627 | Consulting and Counseling for Community Change, Pllc | Community/Behavioral Health | 1313 Cathy Ave, Tahlequah, OK 74464-6609 | 2015-07-22 |
| 1447594502 | Eastern Oklahoma Youth Services, Inc. | Community/Behavioral Health | 511 College Ct, Tahlequah, OK 74464-4747 | 2012-11-15 |
| 1861768384 | Shana Netherlain Davis | Community/Behavioral Health | 1624 Clayton Dr, Tahlequah, OK 74464-8004 | 2012-03-29 |
| 1609147149 | Lisa Ann Lillard | Community/Behavioral Health | 321 E South St, Tahlequah, OK 74464-4024 | 2012-01-13 |
| 1902177447 | Ramona L Burns | Community/Behavioral Health | 203 Jamestown St, Tahlequah, OK 74464-6627 | 2012-01-13 |
| 1417244179 | Melinda Shaver, Psy.d. | Community/Behavioral Health | 315 N College Ave, Tahlequah, OK 74464-2703 | 2011-07-01 |
| 1053641373 | Tenkiller Behavioral Services, Inc. | Community/Behavioral Health | 304 N Muskogee Ave, Tahlequah, OK 74464-2738 | 2010-01-08 |
| 1033443296 | Redefine U | Community/Behavioral Health | 2511 S Muskogee Ave, Tahlequah, OK 74464-5459 | 2009-09-21 |
| Find all providers in TAHLEQUAH | ||||
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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.