Provider Demographics
NPI:1639923410
Name:ELYSIAN BEHAVIORAL HEALTH CORP
Entity Type:Organization
Organization Name:ELYSIAN BEHAVIORAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-394-6953
Mailing Address - Street 1:2005 PARKVIEW DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2145
Mailing Address - Country:US
Mailing Address - Phone:405-394-6953
Mailing Address - Fax:
Practice Address - Street 1:2005 PARKVIEW DR STE 2
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2145
Practice Address - Country:US
Practice Address - Phone:405-394-6953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health