Provider Demographics
NPI:1124705348
Name:RELIANCE MENTAL HEALTH CLINIC
Entity type:Organization
Organization Name:RELIANCE MENTAL HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLINE
Authorized Official - Middle Name:LAMI
Authorized Official - Last Name:EDIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C, PMHNP-C
Authorized Official - Phone:405-501-8806
Mailing Address - Street 1:7415 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5135
Mailing Address - Country:US
Mailing Address - Phone:405-501-8806
Mailing Address - Fax:
Practice Address - Street 1:7415 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5135
Practice Address - Country:US
Practice Address - Phone:405-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty