Provider Demographics
NPI:1043595879
Name:OAKTREE COUNSELING SERVICES
Entity Type:Organization
Organization Name:OAKTREE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-310-5941
Mailing Address - Street 1:2104 NW BRITNI CIR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3121
Mailing Address - Country:US
Mailing Address - Phone:501-310-5941
Mailing Address - Fax:
Practice Address - Street 1:2104 NW BRITNI CIR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3121
Practice Address - Country:US
Practice Address - Phone:501-310-5941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness