Provider Demographics
NPI:1588808109
Name:PUSHMATAHA COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:PUSHMATAHA COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLS-PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, MHR
Authorized Official - Phone:918-825-4872
Mailing Address - Street 1:205 S ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-5201
Mailing Address - Country:US
Mailing Address - Phone:918-825-4872
Mailing Address - Fax:918-825-4873
Practice Address - Street 1:205 S ADAIR ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-5201
Practice Address - Country:US
Practice Address - Phone:918-825-4872
Practice Address - Fax:918-825-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health