Provider Demographics
NPI:1396183448
Name:PREMIER BEHAVIORAL HEALTH & THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PREMIER BEHAVIORAL HEALTH & THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QWANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-365-4275
Mailing Address - Street 1:3700 N CLASSEN BLVD
Mailing Address - Street 2:C35
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2872
Mailing Address - Country:US
Mailing Address - Phone:405-606-8883
Mailing Address - Fax:
Practice Address - Street 1:3700 N CLASSEN BLVD
Practice Address - Street 2:C35
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2872
Practice Address - Country:US
Practice Address - Phone:405-606-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health