Provider Demographics
NPI:1235535352
Name:THE PREVENTION CENTER, LLC
Entity Type:Organization
Organization Name:THE PREVENTION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-215-8527
Mailing Address - Street 1:1800 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2124
Mailing Address - Country:US
Mailing Address - Phone:405-835-6757
Mailing Address - Fax:405-213-1628
Practice Address - Street 1:1800 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2124
Practice Address - Country:US
Practice Address - Phone:405-835-6757
Practice Address - Fax:405-213-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management