| Individual Contractor | |
|
4711 Se 77th St Oklahoma City OK 73135-4544 | |
| (405) 921-3430 | |
| Not Available |
| Full Name | Individual Contractor |
|---|---|
| Speciality | Case Management |
| Location | 4711 Se 77th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Crystal L Walls (BEHAVIOR REHABILITATION SPECIALIST) |
| Authorized Official Contact | 4059213430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Individual Contractor 4711 Se 77th St Oklahoma City OK 73135-4544 Ph: (405) 921-3430 | Individual Contractor 4711 Se 77th St Oklahoma City OK 73135-4544 Ph: (405) 921-3430 |
| NPI Number | 1689967531 |
|---|---|
| Provider Enumeration Date | 05/25/2011 |
| Last Update Date | 10/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689967531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
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