Provider Demographics
NPI:1659611572
Name:MORNINGSTAR MENTAL HEALTH SERVICE
Entity Type:Organization
Organization Name:MORNINGSTAR MENTAL HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASST.
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-650-9500
Mailing Address - Street 1:1501 S SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-3920
Mailing Address - Country:US
Mailing Address - Phone:803-920-4902
Mailing Address - Fax:
Practice Address - Street 1:1501 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-3920
Practice Address - Country:US
Practice Address - Phone:803-920-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty