Organization Name: | SPECTRA MENTAL HEALTH |
NPI Number: | 1073932976 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVONDRA LOVE OWENS (CFO) |
Mailing Address: | 6520 E Reno Ave Suite D Midwest City |
State: | OK US |
Postal Code: | 731102109 |
Phone Number: | 4057330120 |
Fax Number: | 4057337877 |
NPI Enumeration Date: | 04/08/2014 |
NPI Last Update Date: | 04/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |