| Edwin Fair Community Mental Health Center, Inc. | |
|
1500 N 6th St Ponca City OK 74601-2827 | |
| (580) 762-7561 | |
| (580) 762-2576 |
| Full Name | Edwin Fair Community Mental Health Center, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1500 N 6th St, Ponca City, Oklahoma |
| Authorized Official Name and Position | Misty Daniels (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5807627561 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edwin Fair Community Mental Health Center, Inc. 1500 North 6th Street Ponca City OK 74601-2827 Ph: (580) 762-7561 | Edwin Fair Community Mental Health Center, Inc. 1500 N 6th St Ponca City OK 74601-2827 Ph: (580) 762-7561 |
| NPI Number | 1316997992 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 10/08/2012 |
| Medicare PECOS PAC ID | 2466449368 |
|---|---|
| Medicare Enrollment ID | O20040430000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316997992 | NPI | - | NPPES |
| 100749540Q | Medicaid | OK | |
| 100749540U | Medicaid | OK | |
| 100749540B | Medicaid | OK | |
| 100749540W | Medicaid | OK | |
| 100749540R | Medicaid | OK | |
| 100749540L | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Dustin O Hayes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184981144 PECOS PAC ID: 0244465516 Enrollment ID: I20131023001078 |
| Provider Name | James Reed Mcglasson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437696515 PECOS PAC ID: 5496031791 Enrollment ID: I20170718001313 |
Edwin Fair Community Mental Health Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 N 5th St, Ponca City, OK 74601 Phone: 580-762-7561 Fax: 580-762-2576 | |
Grand Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 407 W South Ave, Ponca City, OK 74601 Phone: 580-308-5515 Fax: 580-749-5792 | |
Kara M. Smith, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 425 Fairview Ave, Suite 1, Ponca City, OK 74601 Phone: 580-382-5772 Fax: 580-382-5731 | |
Laura Peitz Counseling Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1912 Lake Rd, Ponca City, OK 74604 Phone: 580-762-6511 Fax: 580-762-6511 | |
Edwin Fair Community Mental Health Center Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 N 6th St, Ponca City, OK 74601 Phone: 580-762-7561 Fax: 580-762-2576 | |
Suzan B. Simmons, Ph.d,,pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1916 Lake Rd, Ponca City, OK 74604 Phone: 580-761-3799 | |
Jan Matheson Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1918 Lake Rd, Ponca City, OK 74604 Phone: 580-765-2581 |