Healthcare Provider Details

I. General information

NPI: 1972217503
Provider Name (Legal Business Name): BOOKOUT COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W 5TH ST
BEGGS OK
74421-3608
US

IV. Provider business mailing address

719 NINNEKAH ST
ENID OK
73701-5200
US

V. Phone/Fax

Practice location:
  • Phone: 580-308-0067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA BOOKOUT
Title or Position: OWNER
Credential:
Phone: 580-308-0067