Provider Demographics
NPI:1376967216
Name:TENKILLER BEHAVIORAL SERVICES, INC.
Entity Type:Organization
Organization Name:TENKILLER BEHAVIORAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-797-7786
Mailing Address - Street 1:27753 S WELLING RD
Mailing Address - Street 2:
Mailing Address - City:WELLING
Mailing Address - State:OK
Mailing Address - Zip Code:74471-2202
Mailing Address - Country:US
Mailing Address - Phone:918-797-7786
Mailing Address - Fax:918-457-4104
Practice Address - Street 1:110 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3100
Practice Address - Country:US
Practice Address - Phone:918-797-7786
Practice Address - Fax:918-696-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708280Medicaid