Provider Demographics
NPI:1013388339
Name:SEASONS OF CHANGE BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SEASONS OF CHANGE BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-519-1096
Mailing Address - Street 1:1019 WATERWOOD PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5329
Mailing Address - Country:US
Mailing Address - Phone:405-726-9808
Mailing Address - Fax:405-726-9809
Practice Address - Street 1:1019 WATERWOOD PKWY STE E
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5329
Practice Address - Country:US
Practice Address - Phone:405-726-9808
Practice Address - Fax:405-726-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4267251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health