Provider Demographics
NPI:1164165486
Name:RED HAWK BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:RED HAWK BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:918-508-9696
Mailing Address - Street 1:1232 S ATLANTA PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4311
Mailing Address - Country:US
Mailing Address - Phone:918-508-9696
Mailing Address - Fax:
Practice Address - Street 1:1218 N FLORENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3755
Practice Address - Country:US
Practice Address - Phone:918-283-4388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty