Healthcare Provider Details

I. General information

NPI: 1578399051
Provider Name (Legal Business Name): CAYDEN JAMES CRUME
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SYCAMORE ST
HOLLIS OK
73550-1436
US

IV. Provider business mailing address

400 E SYCAMORE ST
HOLLIS OK
73550-1436
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-2800
  • Fax: 580-688-2193
Mailing address:
  • Phone: 580-688-2800
  • Fax: 580-688-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCCANDIDATE12331
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: