Provider Demographics
NPI:1912206988
Name:OSTERDOCK, CECIL (BA, BHRS,CM)
Entity Type:Individual
Prefix:MR
First Name:CECIL
Middle Name:
Last Name:OSTERDOCK
Suffix:
Gender:M
Credentials:BA, BHRS,CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-0689
Mailing Address - Country:US
Mailing Address - Phone:580-286-3301
Mailing Address - Fax:580-286-6385
Practice Address - Street 1:104 NE AVE A
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3813
Practice Address - Country:US
Practice Address - Phone:580-286-3301
Practice Address - Fax:580-286-6385
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)