Provider Demographics
NPI:1346509627
Name:SUMMIT BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SUMMIT BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-641-3894
Mailing Address - Street 1:600 NW 23RD ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1469
Mailing Address - Country:US
Mailing Address - Phone:405-601-0423
Mailing Address - Fax:405-601-9626
Practice Address - Street 1:600 NW 23RD ST
Practice Address - Street 2:SUITE 209
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1469
Practice Address - Country:US
Practice Address - Phone:405-601-0423
Practice Address - Fax:405-601-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health