Basic Information
| Provider Information | |||||||||
| NPI: | 1679145486 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIANCE MENTAL HEALTH COMMUNITY PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 521147 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741521147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186080380 | ||||||||
| FaxNumber: | 2094255727 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 W BLUE STARR DR | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740174226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186080380 | ||||||||
| FaxNumber: | 2094255727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2021 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | CANDICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9186080380 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS LPC-S | ||||||||
| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.