Provider Demographics
NPI:1396220844
Name:OKLAHOMA MENTAL HEALTH COUNCIL
Entity Type:Organization
Organization Name:OKLAHOMA MENTAL HEALTH COUNCIL
Other - Org Name:RED ROCK BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL-DUVERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-425-0428
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5104
Mailing Address - Country:US
Mailing Address - Phone:405-424-7711
Mailing Address - Fax:
Practice Address - Street 1:1336 N HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5206
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA MENTAL HEALTH COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-01
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100635250Medicaid