Provider Demographics
NPI:1871887703
Name:EASTERN SKY MENTAL HEALTH, INC
Entity type:Organization
Organization Name:EASTERN SKY MENTAL HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:LEONA
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LBP
Authorized Official - Phone:918-465-0300
Mailing Address - Street 1:301 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-4415
Mailing Address - Country:US
Mailing Address - Phone:918-465-0300
Mailing Address - Fax:918-465-0300
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4415
Practice Address - Country:US
Practice Address - Phone:918-465-0300
Practice Address - Fax:918-465-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty