Provider Demographics
NPI:1033456355
Name:SOUTHERN OKLAHOMA TREATMENT SERVICES
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SHANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-208-9354
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:OK
Mailing Address - Zip Code:73449-0048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1307 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7231
Practice Address - Country:US
Practice Address - Phone:405-208-9354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty