Provider Demographics
NPI:1073509022
Name:MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Other - Org Name:MENTAL HEALTH AND SUBSTANCE CENTERS OF SOUTHERN OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MED, LMFT
Authorized Official - Phone:580-223-5070
Mailing Address - Street 1:2530 S COMMERCE ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5519
Mailing Address - Country:US
Mailing Address - Phone:580-223-5070
Mailing Address - Fax:580-223-5617
Practice Address - Street 1:2530 S COMMERCE ST
Practice Address - Street 2:BUILDING B
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5519
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKMHSSWMedicare ID - Type UnspecifiedMEDICARE