Provider Demographics
NPI:1225352057
Name:STATE OF OKLAHOMA
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:BILL WILLIS CMH & SAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECYTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-207-3000
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-0558
Mailing Address - Country:US
Mailing Address - Phone:918-207-3000
Mailing Address - Fax:918-207-3064
Practice Address - Street 1:400 NORTH OAK
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:OK
Practice Address - Zip Code:74463
Practice Address - Country:US
Practice Address - Phone:918-207-3000
Practice Address - Fax:918-207-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health