Provider Demographics
NPI:1649572439
Name:ASSOCIATIVE THERAPUTIC SERVICES
Entity Type:Organization
Organization Name:ASSOCIATIVE THERAPUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH REHABILITATION SP
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:580-242-4673
Mailing Address - Street 1:1625 W GARRIOTT, STE F
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-242-4673
Mailing Address - Fax:580-242-4679
Practice Address - Street 1:1625 W GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-242-4673
Practice Address - Fax:580-242-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicaid