Provider Demographics
NPI:1700136900
Name:CREOKS MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CREOKS MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-756-9411
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0760
Mailing Address - Country:US
Mailing Address - Phone:918-756-9411
Mailing Address - Fax:918-756-2126
Practice Address - Street 1:2 S COO Y YAH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4636
Practice Address - Country:US
Practice Address - Phone:918-756-9411
Practice Address - Fax:918-756-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCMHC-561251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100734620Medicaid