Provider Demographics
NPI:1457311458
Name:QUAPAW TRIBAL BUSINESS COMMITTEE
Entity Type:Organization
Organization Name:QUAPAW TRIBAL BUSINESS COMMITTEE
Other - Org Name:QUAPAW COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, QCS
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:918-542-1786
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-0876
Mailing Address - Country:US
Mailing Address - Phone:918-542-1853
Mailing Address - Fax:
Practice Address - Street 1:58150 E 66 RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6509
Practice Address - Country:US
Practice Address - Phone:918-542-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty