Provider Demographics
NPI:1518243302
Name:JTCMHC
Entity Type:Organization
Organization Name:JTCMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIAGE SPECIALIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TOURGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-248-5780
Mailing Address - Street 1:5403 RUMBOUGH RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-3056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5403 RUMBOUGH RD UNIT A
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-3056
Practice Address - Country:US
Practice Address - Phone:580-248-5780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)