Provider Demographics
NPI:1972836955
Name:ATOKA COUNSELING SERVICES
Entity Type:Organization
Organization Name:ATOKA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LPC, LADC
Authorized Official - Phone:918-647-5395
Mailing Address - Street 1:309 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4227
Mailing Address - Country:US
Mailing Address - Phone:918-647-5395
Mailing Address - Fax:
Practice Address - Street 1:309 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4227
Practice Address - Country:US
Practice Address - Phone:918-647-5395
Practice Address - Fax:918-647-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3134251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health