Provider Demographics
NPI:1831315175
Name:SHELTERED WORKSHOP FOR PAYNE COUNTY, INC.
Entity Type:Organization
Organization Name:SHELTERED WORKSHOP FOR PAYNE COUNTY, INC.
Other - Org Name:SWPC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:405-377-0834
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-1509
Mailing Address - Country:US
Mailing Address - Phone:405-377-0834
Mailing Address - Fax:405-377-0860
Practice Address - Street 1:516 EXPO CIRCLE SOUTH
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-377-0834
Practice Address - Fax:405-377-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty