Provider Demographics
NPI:1770908675
Name:CREOKS MENTAL HEALTH SERVICES, INC., DBA TRUWELLNESS RX
Entity type:Organization
Organization Name:CREOKS MENTAL HEALTH SERVICES, INC., DBA TRUWELLNESS RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOHEALTH HELPDESK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-382-7300
Mailing Address - Street 1:PO BOX 700360
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0360
Mailing Address - Country:US
Mailing Address - Phone:918-382-7300
Mailing Address - Fax:918-382-7302
Practice Address - Street 1:105 EAST ROSS AVENUE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6423
Practice Address - Country:US
Practice Address - Phone:918-216-4628
Practice Address - Fax:918-216-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11-65223336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100734620Medicaid
OK11-7996OtherPHARMACY LICENSE