Provider Demographics
NPI:1235351552
Name:NORTHWEST DOMESTIC CRISIS SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHWEST DOMESTIC CRISIS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-256-1215
Mailing Address - Street 1:1323 KANSAS ST.
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801
Mailing Address - Country:US
Mailing Address - Phone:580-256-1215
Mailing Address - Fax:580-256-1245
Practice Address - Street 1:1330 OKLAHOMA BLVD.
Practice Address - Street 2:
Practice Address - City:ALVA,
Practice Address - State:OK
Practice Address - Zip Code:73717
Practice Address - Country:US
Practice Address - Phone:580-327-6648
Practice Address - Fax:580-327-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health