Organization Name: | DEDICATED OUTPATIENT THERAPY SERVICES, LLC |
NPI Number: | 1215293220 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JILL M BASHORUN (OWNER) |
Mailing Address: | 920770 Deer Ridge Ln Wellston |
State: | OK US |
Postal Code: | 748818146 |
Phone Number: | 4056507278 |
Fax Number: | |
NPI Enumeration Date: | 04/03/2012 |
NPI Last Update Date: | 04/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2206 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |