Provider Demographics
NPI:1659511954
Name:HEALTHY OPTIONS FOR PREVENTION AND EFFECTIVE TREATMENT OKLAHOMA
Entity Type:Organization
Organization Name:HEALTHY OPTIONS FOR PREVENTION AND EFFECTIVE TREATMENT OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELANESE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-431-0232
Mailing Address - Street 1:5350 S WESTERN AVE
Mailing Address - Street 2:305
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4520
Mailing Address - Country:US
Mailing Address - Phone:405-632-2949
Mailing Address - Fax:877-245-1779
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:305
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4520
Practice Address - Country:US
Practice Address - Phone:405-632-2949
Practice Address - Fax:877-245-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200235120AMedicaid