Provider Demographics
NPI:1720417587
Name:ODMHASA
Entity Type:Organization
Organization Name:ODMHASA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPRSS
Authorized Official - Prefix:MS
Authorized Official - First Name:WINDI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPRSS
Authorized Official - Phone:405-569-9448
Mailing Address - Street 1:717 N DILLON AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3716
Mailing Address - Country:US
Mailing Address - Phone:405-569-9448
Mailing Address - Fax:
Practice Address - Street 1:717 N DILLON AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3716
Practice Address - Country:US
Practice Address - Phone:405-569-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health