Provider Demographics
NPI:1033443296
Name:REDEFINE U
Entity Type:Organization
Organization Name:REDEFINE U
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MHR/LADC # 624
Authorized Official - Phone:918-431-0634
Mailing Address - Street 1:2511 S MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5459
Mailing Address - Country:US
Mailing Address - Phone:918-431-0634
Mailing Address - Fax:908-431-0654
Practice Address - Street 1:2511 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5459
Practice Address - Country:US
Practice Address - Phone:918-431-0634
Practice Address - Fax:908-431-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health