Basic Information
Provider Information | |||||||||
NPI: | 1538334826 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ALTERNATIVE OPPORTUNITIES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DAYSPRING COMMUNITY SERVICEW | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5525 E 51ST ST | ||||||||
Address2: | SUITE 400 | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741357461 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9183886457 | ||||||||
FaxNumber: | 9183886456 | ||||||||
Practice Location | |||||||||
Address1: | 211 W MAIN ST | ||||||||
Address2: |   | ||||||||
City: | WILBURTON | ||||||||
State: | OK | ||||||||
PostalCode: | 745784045 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9184651100 | ||||||||
FaxNumber: | 9184659020 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2008 | ||||||||
LastUpdateDate: | 04/28/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JARMAN | ||||||||
AuthorizedOfficialFirstName: | JILL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
AuthorizedOfficialTelephone: | 9183886457 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.