Provider Demographics
NPI:1447596192
Name:KREATIVE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:KREATIVE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-642-4871
Mailing Address - Street 1:5929 N MAY AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3909
Mailing Address - Country:US
Mailing Address - Phone:405-254-5040
Mailing Address - Fax:
Practice Address - Street 1:5929 N MAY AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3909
Practice Address - Country:US
Practice Address - Phone:405-254-5040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management