Provider Demographics
NPI:1437914777
Name:KEETOOWAH CHEROKEE TREATMENT SERVICES
Entity Type:Organization
Organization Name:KEETOOWAH CHEROKEE TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LEEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-316-1468
Mailing Address - Street 1:16414 W 760 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-1675
Mailing Address - Country:US
Mailing Address - Phone:918-708-9009
Mailing Address - Fax:
Practice Address - Street 1:1367 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2848
Practice Address - Country:US
Practice Address - Phone:918-708-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health