Provider Demographics
NPI:1619208147
Name:SPUR OUTPATIENT SERVICES DBA SOUTHWEST FOSTER CARE
Entity Type:Organization
Organization Name:SPUR OUTPATIENT SERVICES DBA SOUTHWEST FOSTER CARE
Other - Org Name:SWFC DBA SPUR PILOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-848-0011
Mailing Address - Street 1:4801 N. CLASSEN BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4624
Mailing Address - Country:US
Mailing Address - Phone:405-848-0011
Mailing Address - Fax:405-848-2111
Practice Address - Street 1:4801 N CLASSEN BLVD STE 135
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4624
Practice Address - Country:US
Practice Address - Phone:405-848-0011
Practice Address - Fax:405-848-2111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST FOSTER CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1465261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health