Provider Demographics
NPI:1710296272
Name:SHADOW MOUNTAIN BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SHADOW MOUNTAIN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTINUING CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MCGUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-493-3223
Mailing Address - Street 1:6262 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4055
Mailing Address - Country:US
Mailing Address - Phone:918-493-3223
Mailing Address - Fax:918-493-3285
Practice Address - Street 1:6262 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4055
Practice Address - Country:US
Practice Address - Phone:918-493-3223
Practice Address - Fax:918-493-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK8500226283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital