Provider Demographics
NPI:1851415673
Name:CIMARRON VALLEY THERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:CIMARRON VALLEY THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MBS, LBP
Authorized Official - Phone:580-254-2886
Mailing Address - Street 1:205 W HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1547
Mailing Address - Country:US
Mailing Address - Phone:580-765-0076
Mailing Address - Fax:580-765-0073
Practice Address - Street 1:205 W HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1547
Practice Address - Country:US
Practice Address - Phone:580-765-0076
Practice Address - Fax:580-765-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK8600113261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)