Provider Demographics
NPI:1992837603
Name:COUNSELING AND RECOVERY SERVICES OF OKLAHOMA, INC.
Entity Type:Organization
Organization Name:COUNSELING AND RECOVERY SERVICES OF OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-2554
Mailing Address - Street 1:7010 S YALE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5743
Mailing Address - Country:US
Mailing Address - Phone:918-492-2554
Mailing Address - Fax:918-494-9870
Practice Address - Street 1:401 E BROADWAY CT
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7939
Practice Address - Country:US
Practice Address - Phone:918-245-5565
Practice Address - Fax:918-245-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100733450IMedicaid