Basic Information
| Provider Information | |||||||||
| NPI: | 1558505701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OKLAHOMA MENTAL HEALTH COUNCIL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RED ROCK BEHAVIORAL HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 N LINCOLN BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731055104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054250428 | ||||||||
| FaxNumber: | 4054193042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 WEST COMMERCE | ||||||||
| Address2: | |||||||||
| City: | YUKON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053541927 | ||||||||
| FaxNumber: | 4053543927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | FOUST | ||||||||
| AuthorizedOfficialFirstName: | VERNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4054247711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 100635250R | 05 | OK | MEDICAID |