Provider Demographics
NPI:1972830933
Name:CREOKS BEHAVIORAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CREOKS BEHAVIORAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRESCTOR OF INTENSIVE OUTPATIENT P
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, BCPC
Authorized Official - Phone:918-592-1622
Mailing Address - Street 1:14701 COURTNEY LN
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3556
Mailing Address - Country:US
Mailing Address - Phone:918-814-5718
Mailing Address - Fax:918-322-6168
Practice Address - Street 1:2725 E SKELLY DR STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6253
Practice Address - Country:US
Practice Address - Phone:918-814-5718
Practice Address - Fax:918-322-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health