Provider Demographics
NPI:1376976852
Name:EXCEPTIONAL MINDS THERAPEUTIC CHILD DEVELOPMENT SERVICES INC
Entity Type:Organization
Organization Name:EXCEPTIONAL MINDS THERAPEUTIC CHILD DEVELOPMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-0433
Mailing Address - Street 1:501 S COLTRANE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6714
Mailing Address - Country:US
Mailing Address - Phone:405-285-0433
Mailing Address - Fax:
Practice Address - Street 1:501 S COLTRANE RD BLDG A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6714
Practice Address - Country:US
Practice Address - Phone:405-285-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management