Provider Demographics
NPI:1659855278
Name:INTEGRATED THERAPY SOLUTIONS OF OKLAHOMA, LLC
Entity Type:Organization
Organization Name:INTEGRATED THERAPY SOLUTIONS OF OKLAHOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DUPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-208-4469
Mailing Address - Street 1:620 NW 5TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3947
Mailing Address - Country:US
Mailing Address - Phone:405-208-4469
Mailing Address - Fax:405-208-4472
Practice Address - Street 1:620 NW 5TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3947
Practice Address - Country:US
Practice Address - Phone:405-208-4469
Practice Address - Fax:405-208-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200850330AMedicaid