Provider Demographics
NPI:1710174107
Name:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Other - Org Name:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-766-2311
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:FORT SUPPLY
Mailing Address - State:OK
Mailing Address - Zip Code:73841-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:193461 E CT RD 304
Practice Address - Street 2:
Practice Address - City:FORT SUPPLY
Practice Address - State:OK
Practice Address - Zip Code:73841-0001
Practice Address - Country:US
Practice Address - Phone:580-766-2311
Practice Address - Fax:580-766-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44-25933336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100704080AMedicaid
OK100704080BMedicaid
2074624OtherPK