Provider Demographics
NPI:1578014031
Name:HERITAGE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:HERITAGE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGREH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-5998
Mailing Address - Street 1:121 COLLIER DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 COLLIER DR STE 600
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5279
Practice Address - Country:US
Practice Address - Phone:405-928-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty