NPIMap

Organization Active NPI

State of Oklahoma; Dba:Bill Willis Community Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tahlequah, OK
National Provider Identifier
1508987959
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
36-4537 Issued in OK
Legal business name
STATE OF OKLAHOMA; DBA:BILL WILLIS COMMUNITY MENTAL HEALTH CENTER
Practice address
1400 S. Hensley Dr
Tahlequah, OK 74465-0558
Phone
(918) 207-3049
Fax
(918) 207-3065
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Walter Michael Kinney, DPH
Title
Director of Pharmacy
Phone
(918) 207-3049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 36-4537 OK Primary

Addresses

Primary practice location

1400 S. Hensley Dr
Tahlequah, OK 74465-0558

Mailing address

1400 S. Hensley Dr
P.O. Box 558
Tahlequah, OK 74465-0558
Phone (918) 207-3049

Other identifiers 2

IdentifierTypeStateIssuer
29393OtherOKSTATE BNDD CONTROL NUMBER
364537OtherOKSTATE BOARD OF PHARMACY L

National Provider Directory

National Provider Directory
Tax ID family
Sallisaw State Veterans Home140 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1508987959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S. HENSLEY DR",
            "address_2": "P.O. BOX 558",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744650558",
            "telephone_number": "918-207-3049",
            "fax_number": "918-207-3065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S. HENSLEY DR",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744650558",
            "telephone_number": "918-207-3049",
            "fax_number": "918-207-3065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF OKLAHOMA; DBA:BILL WILLIS COMMUNITY MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KINNEY",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "918-207-3049",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OK",
            "license": "36-4537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BNDD CONTROL NUMBER",
            "identifier": "29393",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF PHARMACY L",
            "identifier": "364537",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.