Provider Demographics
NPI:1720383516
Name:CREOKS BEHAVIORAL HEALTH SERVICCES
Entity Type:Organization
Organization Name:CREOKS BEHAVIORAL HEALTH SERVICCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONDRA
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:MARZETT
Authorized Official - Suffix:
Authorized Official - Credentials:BA; MS
Authorized Official - Phone:918-851-2129
Mailing Address - Street 1:2725 E SKELLY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6253
Mailing Address - Country:US
Mailing Address - Phone:918-592-1622
Mailing Address - Fax:918-392-3328
Practice Address - Street 1:2725 E SKELLY DR STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6253
Practice Address - Country:US
Practice Address - Phone:918-592-1622
Practice Address - Fax:918-392-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH080870444251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health