| Organization Name: | SOUTHSIDE BEHAVIORAL HEALTH LLC |
| NPI Number: | 1487056446 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMY MARIE BROWN (LIC PROF COUNSELOR/OWNER/MANAGER) |
| Mailing Address: | 124 N 1st St Jenks |
| State: | OK US |
| Postal Code: | 740373912 |
| Phone Number: | 9186979345 |
| Fax Number: | |
| NPI Enumeration Date: | 09/22/2014 |
| NPI Last Update Date: | 09/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 5244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |