Provider Demographics
NPI:1790322402
Name:LEADINGAGE OKLAHOMA
Entity Type:Organization
Organization Name:LEADINGAGE OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-640-8040
Mailing Address - Street 1:PO BOX 1383
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-1383
Mailing Address - Country:US
Mailing Address - Phone:405-640-8040
Mailing Address - Fax:405-262-5252
Practice Address - Street 1:804 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5699
Practice Address - Country:US
Practice Address - Phone:405-640-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)