Provider Demographics
NPI:1619261377
Name:ELITE PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:ELITE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC
Authorized Official - Phone:580-564-7308
Mailing Address - Street 1:413 HIGHWAY 70 N
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-8235
Mailing Address - Country:US
Mailing Address - Phone:580-564-7308
Mailing Address - Fax:580-564-7309
Practice Address - Street 1:413 HIGHWAY 70 N
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-8235
Practice Address - Country:US
Practice Address - Phone:580-564-7308
Practice Address - Fax:580-564-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-30
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1225065006Medicaid