Provider Demographics
NPI:1114401767
Name:VITAL BEHAVIROL HEALTH
Entity Type:Organization
Organization Name:VITAL BEHAVIROL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:405-498-3341
Mailing Address - Street 1:4605 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-5009
Mailing Address - Country:US
Mailing Address - Phone:405-498-3341
Mailing Address - Fax:405-498-3371
Practice Address - Street 1:4605 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-5009
Practice Address - Country:US
Practice Address - Phone:405-498-3341
Practice Address - Fax:405-498-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health