Provider Demographics
NPI:1245632306
Name:EASTERN OKLAHOMA MENTAL HEALTH & COUNSELING LLC
Entity type:Organization
Organization Name:EASTERN OKLAHOMA MENTAL HEALTH & COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:918-649-0011
Mailing Address - Street 1:210 S WILSON ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4917
Mailing Address - Country:US
Mailing Address - Phone:918-649-0011
Mailing Address - Fax:918-649-0066
Practice Address - Street 1:210 S WILSON ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4917
Practice Address - Country:US
Practice Address - Phone:918-649-0011
Practice Address - Fax:918-649-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-20
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health