Provider Demographics
NPI:1659961530
Name:ALLIANCE MENTAL HEALTH, LLC.
Entity Type:Organization
Organization Name:ALLIANCE MENTAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-608-0380
Mailing Address - Street 1:PO BOX 521147
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-1147
Mailing Address - Country:US
Mailing Address - Phone:918-608-0380
Mailing Address - Fax:
Practice Address - Street 1:217 N WATER AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2825
Practice Address - Country:US
Practice Address - Phone:918-608-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE MENTAL HEALTH, LLOC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-25
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200345410BMedicaid