Provider Demographics
NPI:1073932976
Name:SPECTRA MENTAL HEALTH
Entity Type:Organization
Organization Name:SPECTRA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVONDRA
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-733-0120
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-0223
Mailing Address - Country:US
Mailing Address - Phone:405-733-0120
Mailing Address - Fax:405-733-7877
Practice Address - Street 1:6520 E RENO AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2109
Practice Address - Country:US
Practice Address - Phone:405-733-0120
Practice Address - Fax:405-733-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty