Provider Demographics
NPI:1083983639
Name:CRISIS CONTROL CENTER
Entity Type:Organization
Organization Name:CRISIS CONTROL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:CM
Authorized Official - Phone:580-924-3056
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0113
Mailing Address - Country:US
Mailing Address - Phone:580-924-3056
Mailing Address - Fax:
Practice Address - Street 1:115 N 12TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4767
Practice Address - Country:US
Practice Address - Phone:580-924-3056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7096251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management