STATE OF OKLAHOMA; DBA:BILL WILLIS COMMUNITY MENTAL HEALTH CENTER (NPI# 1508987959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508987959 |
| Entity Type | Organization |
| Organization Name | STATE OF OKLAHOMA; DBA:BILL WILLIS COMMUNITY MENTAL HEALTH CENTER |
| Practice Address |
1400 S. Hensley Dr Tahlequah OK 74465-0558 |
| Mailing Address |
1400 S. Hensley Dr P.o. Box 558 Tahlequah OK 74465-0558 |
| Practice Telephone | 9182073049 |
| Practice Fax Number | 9182073065 |
| Mailing Telephone | 9182073049 |
| Mailing Fax Number | 9182073065 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2008-06-25 |
| Authorized Official Name | MR. WALTER MICHAEL KINNEY (DIRECTOR OF PHARMACY) |
| Authorized Official Telephone | 9182073049 |
| Authorized Official Credential | DPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
36-4537 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | DEA NUMBER | BB4346246 | 01 |
| OK | STATE BNDD CONTROL NUMBER | 29393 | 01 |
| OK | STATE BOARD OF PHARMACY L | 364537 | 01 |
| Street Address |
1400 S. HENSLEY DR |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74465-0558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780939223 | Jack Brown Treatment Center | Substance Abuse Rehabilitation Facility | 17091 S Muskogee Ave, Tahlequah, OK 74465 | 2012-07-20 |
| 1437396850 | Jack Brown Center | Substance Abuse Rehabilitation Facility | 17091 South Muskogee Avenue, Tahlequah, OK 74465 | 2009-01-08 |
| 1821287962 | Cornerstone Home Health Care | Home Health | 1699 West Fourth Street, Tahlequah, OK 74465 | 2007-10-15 |
| 1144414764 | Adam Carroll Cothran | Social Worker | 17675 S. Muskogee Ave., Tahlequah, OK 74465 | 2007-08-28 |
| 1194895441 | Eeg Corporation | Psychiatry & Neurology | 1400 E Downing, Tahlequah, OK 74465 | 2006-11-08 |
| 1700951050 | Harold Earl Goldman | Pediatrics | 1400 E Downing, Tahlequah, OK 74465 | 2006-11-22 |
| 1609123892 | Sonya Davidson | Counselor | 17091 S Muskogee Ave, Tahlequah, OK 74465-0000 | 2012-08-07 |
| 1386914646 | Debra Lee Johnson | Case Manager/Care Coordinator | 17091 South Muskogee Avenue, Cherokee Nation, Tahlequah, OK 74465-0948 | 2012-01-04 |
| 1770937229 | Talking Leaves Job Corps | Psychologist | 5700 Bald Hill Road, Tahlequah, OK 74465-1066 | 2016-04-21 |
| 1689909574 | Lori Elizabeth Medina | Counselor | 17091 S. Muskogee, Tahlequah, OK 74465-4405 | 2009-10-09 |
| Find all providers in zip 74465 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235295130 | People Inc. of Sequoyah Co | Clinic/Center | 1606 E Downing St, Tahlequah, OK 74464-2513 | 2006-12-28 |
| 1407228752 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2015-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870742 | Sequelcare of Oklahoma, LLC | Clinic/Center | 6218 S Lewis Ave Ste 118, Tulsa, OK 74136-1018 | 2020-10-28 |
| 1649870890 | M & M Counseling Group, LLC | Clinic/Center | 207 S Czech Hall Rd, Yukon, OK 73099-6851 | 2020-10-27 |
| 1992303721 | Misty Watkins | Clinic/Center | 1601 Sw Parkridge Blvd Ste 200, Lawton, OK 73505-7564 | 2020-10-14 |
| 1295342046 | Integrative Healthcare Solutions LLC | Clinic/Center | 2227 E 8th St, Tulsa, OK 74104-3237 | 2020-09-25 |
| 1235744020 | Strength of A Warrior Counseling Services LLC | Clinic/Center | 4516 Se 25th St, Del City, OK 73115-4114 | 2020-09-09 |
| 1609488253 | Alexie Foster, LLC | Clinic/Center | 16802 S 301st West Ave, Bristow, OK 74010-2265 | 2020-08-17 |
| 1306455068 | Restore Family Counseling, LLC | Clinic/Center | 100 W. Wilshire, Suite #c3, Oklahoma City, OK 73116 | 2020-07-29 |
| 1245855857 | Dragonfly Psychotherapy | Clinic/Center | 2942 Ne Orlie Dr, Forest Park, OK 73121-2436 | 2020-06-09 |
| 1508480872 | Maria Nancy Martinez | Clinic/Center | 5350 S Western Ave Ste 217, Oklahoma City, OK 73109-4525 | 2020-06-03 |
| 1649894015 | Miranda Rackers | Clinic/Center | 1308 E Mckinley Ave, Sapulpa, OK 74066-4824 | 2020-06-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on STATE OF OKLAHOMA; DBA:BILL WILLIS COMMUNITY MENTAL HEALTH CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.