NPI 1821003658

Providence Service Corporation

Organisation Public Health or Welfare Agency Lawton, OK

Practice location

Address: 4645 W Gore Blvd Suite 5, Lawton, OK 73505-6041
Phone: (580) 355-6800

Authorised official

Name: Aglaia 'Alexis' Martin
Title: Therapist
Phone: (580) 355-6800

Registered specialties

Public Health or Welfare Agency Primary

Agencies Taxonomy 251K00000X Licence 2560 (OK)

Other Public Health or Welfare providers in Oklahoma →

Registry record

NPI: 1821003658
Entity type: Organization
NPI issued: 30 Jul 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.