Provider Demographics
NPI:1245243450
Name:S-OKLA PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:S-OKLA PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARTSELL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:903-463-3730
Mailing Address - Street 1:2402 W MORTON ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1402
Mailing Address - Country:US
Mailing Address - Phone:903-463-3730
Mailing Address - Fax:903-463-3799
Practice Address - Street 1:309 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4227
Practice Address - Country:US
Practice Address - Phone:918-649-0909
Practice Address - Fax:918-649-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK672261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)