Basic Information
| Provider Information | |||||||||
| NPI: | 1003060450 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RED RIVER COUNSELING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 831 | ||||||||
| Address2: | |||||||||
| City: | HUGO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747430831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803269475 | ||||||||
| FaxNumber: | 5803269028 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | HUGO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747434005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803269475 | ||||||||
| FaxNumber: | 5803269475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 10/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | CALLAWAY | ||||||||
| AuthorizedOfficialFirstName: | JANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5803269475 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.