MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA (NPI# 1295871499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295871499 |
| Entity Type | Organization |
| Organization Name | MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA |
| Practice Address |
200 Wanda St Marietta OK 73448 |
| Mailing Address |
Po Box 189 Ardmore OK 73402-0189 |
| Practice Telephone | 5802235070 |
| Practice Fax Number | 5802235617 |
| Mailing Telephone | 5802235070 |
| Mailing Fax Number | 5802235617 |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-12-12 |
| Authorized Official Name | ROBERT E LEE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5802235070 |
| Authorized Official Credential | LCSW |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100728830 I | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235394792 | Mental Health Services of Southern Oklahoma | Case Management | 93 Broadlawn Village, Ardmore, OK 73401-1722 | 2008-07-24 |
| 1922266964 | Mental Health Services of Southern Oklahoma | Community/Behavioral Health | #2 Broadlawn, Ardmore, OK 73402-1722 | 2008-05-27 |
| 1144404252 | Mental Health Services of Southern Oklahoma | Clinic/Center | 91 Broadlawn, Ardmore, OK 73401 | 2007-12-26 |
| 1780867812 | Mental Health Services of Southern Oklahoma | Clinic/Center | 209 E Wilson St, Tishomingo, OK 73460-2200 | 2007-12-12 |
| 1760528970 | Mental Health Services of Southern Oklahoma | Case Management | 200 Wanda St, Marietta, OK 73448 | 2007-01-29 |
| 1710023924 | Mental Health Services of Southern Oklahoma | Clinic/Center | 93 Broadlawn, Ardmore, OK 73401-6337 | 2007-01-29 |
| 1992841100 | Mental Health Services of Southern Oklahoma | Case Management | 111 E 12th St, Ada, OK 74820-6501 | 2007-01-29 |
| 1972659910 | Mental Health Services of Southern Oklahoma | Clinic/Center | 603 S 1st St, Madill, OK 73446-3807 | 2007-01-25 |
| 1831245885 | Mental Health Services of Southern Oklahoma | Clinic/Center | 414 W Muskogee Ave, Sulphur, OK 73086-4614 | 2007-01-25 |
| 1518997097 | Mental Health Services of Southern Oklahoma | Community/Behavioral Health | 2530 S. Commerce, Building A, Ardmore, OK 73401-5519 | 2006-07-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA | 1012 14th Ave Nw, Ardmore, OK 73401-5734 |
| Oklahoma Business Registrations | MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA | Po Box 189, Ardmore, OK 73402 |
| Oklahoma Business Registrations | MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA, INC. |
| Street Address |
200 WANDA ST |
| City | MARIETTA |
| State | OK |
| Zip Code | 73448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760528970 | Mental Health Services of Southern Oklahoma | Case Management | 200 Wanda St, Marietta, OK 73448 | 2007-01-29 |
| 1538583430 | Love County Health Center | Community/Behavioral Health | 200 Wanda St, Marietta, OK 73448-1204 | 2014-02-12 |
| 1184047029 | Love County Health Center | Community/Behavioral Health | 200 Wanda St, Marietta, OK 73448-1204 | 2014-01-29 |
| 1154695740 | Susan Raelene Miller | Counselor | 200 Wanda St, Marietta, OK 73448-1204 | 2012-02-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992958805 | Christi Lynn Hallum | Counselor | 200 Wanda Street, Marietta, OK 73448 | 2008-10-23 |
| 1831340041 | Shelly Renee Cumberledge | Counselor | 404 E. Pine St, Marietta, OK 73448 | 2008-10-07 |
| 1083811871 | Doris Jean Petty | Registered Nurse | 200 Wanda, Marietta, OK 73448 | 2007-06-27 |
| 1114093002 | Charles Reid Schnorrenberg | Pharmacist | 300 S Highway 77, Marietta, OK 73448 | 2006-11-24 |
| 1588866107 | Pamela Rae Lynn | Counselor | 200 Wanda, Marietta, OK 73448-0506 | 2007-06-05 |
| 1912944646 | Love County Health Center | General Acute Care Hospital | 300 Wanda Steet, Marietta, OK 73448-1200 | 2006-06-01 |
| 1649221557 | Love County Health Center | General Acute Care Hospital | 300 Wanda Street, Marietta, OK 73448-1200 | 2006-05-15 |
| 1134179641 | Tad Alan Hall | Physician Assistant | 300 Wanda St, Marietta, OK 73448-1200 | 2006-05-12 |
| 1184080145 | Maria Maynard | Physician Assistant | 300 Wanda St, Marietta, OK 73448-1200 | 2016-01-06 |
| 1518380815 | Brittany Flemings | Physician Assistant | 300 Wanda St, Marietta, OK 73448-1200 | 2014-01-23 |
| Find all providers in zip 73448 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1962849927 | Angels In Disguise Counseling and Assessments, LLC | Clinic/Center | 3655 Canton Rd, Ste 110, Marietta, GA 30066-2690 | 2013-05-31 |
| 1023289022 | Recovery Solutions, PC | Clinic/Center | 3417 Canton Rd, Suite 402, Marietta, GA 30066-2896 | 2008-03-18 |
| 1306023494 | Oasis Counseling Inc | Clinic/Center | 379 Atlanta St Se, Marietta, GA 30060-2258 | 2008-01-30 |
| 1548889728 | Marcus Graham & Associates | Clinic/Center | 199 Frasier St Se, Marietta, GA 30060-2201 | 2020-04-08 |
| 1700421732 | Accepted Family Therapy Center | Clinic/Center | 1640 Powers Ferry Rd Se Ste 175, Marietta, GA 30067-5491 | 2019-11-13 |
| 1336613934 | Foundation Counseling, LLC | Clinic/Center | 2655 Dallas Hwy Sw Ste 240, Marietta, GA 30064-2597 | 2019-01-16 |
| 1265913792 | Kristina Cooke, Lcsw, LLC | Clinic/Center | 2854 Johnson Ferry Rd Ste 200, Marietta, GA 30062-5699 | 2018-08-23 |
| Find all providers in MARIETTA | ||||
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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.