Provider Demographics
NPI:1053747253
Name:MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Entity type:Organization
Organization Name:MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-798-4523
Mailing Address - Street 1:1219 K ST NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1801
Mailing Address - Country:US
Mailing Address - Phone:580-798-4523
Mailing Address - Fax:
Practice Address - Street 1:1219 K ST NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1801
Practice Address - Country:US
Practice Address - Phone:580-798-4523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management