Provider Demographics
NPI:1588041560
Name:CORASPIRE MENTAL HEALTH AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:CORASPIRE MENTAL HEALTH AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-830-5732
Mailing Address - Street 1:307 E DANFORTH RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4483
Mailing Address - Country:US
Mailing Address - Phone:405-726-8966
Mailing Address - Fax:405-726-8967
Practice Address - Street 1:307 E DANFORTH RD
Practice Address - Street 2:SUITE 124
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4483
Practice Address - Country:US
Practice Address - Phone:405-726-8966
Practice Address - Fax:405-726-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management