| Organization Name: | PROVIDENCE SERVICE CORPORATION |
| NPI Number: | 1821003658 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AGLAIA 'ALEXIS' MARTIN (THERAPIST) |
| Mailing Address: | 4645 W Gore Blvd Suite 5 Lawton |
| State: | OK US |
| Postal Code: | 735056041 |
| Phone Number: | 5803556800 |
| Fax Number: | |
| NPI Enumeration Date: | 07/30/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 2560 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |