Provider Demographics
NPI:1376742585
Name:ABSENTEE SHAWNEE COUNSELING SERVICES
Entity Type:Organization
Organization Name:ABSENTEE SHAWNEE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, LADC
Authorized Official - Phone:405-672-3033
Mailing Address - Street 1:1301 SE 59TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-7307
Mailing Address - Country:US
Mailing Address - Phone:405-672-3033
Mailing Address - Fax:405-672-8371
Practice Address - Street 1:1301 SE 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-7307
Practice Address - Country:US
Practice Address - Phone:405-672-3033
Practice Address - Fax:405-672-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKODMHSAS276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1417289356Medicaid
OK1538363320Medicaid
OK1750682001Medicaid
OK1376775775Medicaid
OK1639409626Medicaid
OK1376775775Medicaid
OKD34587Medicare UPIN