Healthcare Provider Details

I. General information

NPI: 1164955597
Provider Name (Legal Business Name): ANNE TARGOS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S MAIN ST
HOBART OK
73651-3628
US

IV. Provider business mailing address

986 RED CLOUD CT
ALTUS OK
73521-7635
US

V. Phone/Fax

Practice location:
  • Phone: 580-726-2452
  • Fax:
Mailing address:
  • Phone: 210-273-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: