Provider Demographics
NPI:1164590790
Name:CIMARRON VALLEY THERAPEUTIC SERVICE, INC.
Entity Type:Organization
Organization Name:CIMARRON VALLEY THERAPEUTIC SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MBS, LBP
Authorized Official - Phone:580-254-2886
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-1041
Mailing Address - Country:US
Mailing Address - Phone:580-254-2886
Mailing Address - Fax:580-254-3548
Practice Address - Street 1:1005 9TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3131
Practice Address - Country:US
Practice Address - Phone:580-254-2886
Practice Address - Fax:580-254-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK8600113322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children