Provider Demographics
NPI:1851618599
Name:PSACMA
Entity Type:Organization
Organization Name:PSACMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM ASST
Authorized Official - Prefix:
Authorized Official - First Name:WYNONA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-520-8336
Mailing Address - Street 1:2611 N MLK AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2611 N MLK AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-3313
Practice Address - Country:US
Practice Address - Phone:405-424-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health