Provider Demographics
NPI:1003135260
Name:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SERVICE SPECIALIST II
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS DEGREE
Authorized Official - Phone:580-766-2311
Mailing Address - Street 1:RR 3 BOX 57
Mailing Address - Street 2:
Mailing Address - City:LAVERNE
Mailing Address - State:OK
Mailing Address - Zip Code:73848-9404
Mailing Address - Country:US
Mailing Address - Phone:580-302-1314
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 57
Practice Address - Street 2:
Practice Address - City:LAVERNE
Practice Address - State:OK
Practice Address - Zip Code:73848
Practice Address - Country:US
Practice Address - Phone:580-302-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit