Provider Demographics
NPI:1609236041
Name:CREATING CHANGE
Entity Type:Organization
Organization Name:CREATING CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINH
Authorized Official - Middle Name:THE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-474-6741
Mailing Address - Street 1:373 S YUKON PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4596
Mailing Address - Country:US
Mailing Address - Phone:405-265-0986
Mailing Address - Fax:
Practice Address - Street 1:373 S YUKON PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4596
Practice Address - Country:US
Practice Address - Phone:405-265-0986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)