Provider Demographics
NPI:1003005943
Name:DEVELOPMENTAL ASSESSMENT & INTERVENTION CENTER
Entity Type:Organization
Organization Name:DEVELOPMENTAL ASSESSMENT & INTERVENTION CENTER
Other - Org Name:THE DAI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-226-9222
Mailing Address - Street 1:301 WEST MAIN
Mailing Address - Street 2:SUITE 324
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6322
Mailing Address - Country:US
Mailing Address - Phone:580-226-9222
Mailing Address - Fax:580-226-9226
Practice Address - Street 1:301 WEST MAIN
Practice Address - Street 2:SUITE 324
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6322
Practice Address - Country:US
Practice Address - Phone:580-226-9222
Practice Address - Fax:580-226-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty