| State Of Oklahoma | |
|
Northwest Center For Behavioral Health 1425 N. Main, Suite 1 Fairview OK 73737 | |
| (580) 227-2088 | |
| (580) 227-2349 |
| Full Name | State Of Oklahoma |
|---|---|
| Speciality | Community/behavioral Health |
| Location | Northwest Center For Behavioral Health, Fairview, Oklahoma |
| Authorized Official Name and Position | Trudy Hoffman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5805713233 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Oklahoma Northwest Center For Behavioral Health 1222 10th Street, Suite 211 Woodward OH 73801-3156 Ph: (580) 571-3217 | State Of Oklahoma Northwest Center For Behavioral Health 1425 N. Main, Suite 1 Fairview OK 73737 Ph: (580) 227-2088 |
| NPI Number | 1487727699 |
|---|---|
| Provider Enumeration Date | 11/16/2006 |
| Last Update Date | 02/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487727699 | NPI | - | NPPES |
| 100749430A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Amanda Wiens Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1425 N Main St, Ste 2, Fairview, OK 73737 Phone: 405-664-7540 Fax: 580-701-2658 |