Healthcare Provider Details

I. General information

NPI: 1902700230
Provider Name (Legal Business Name): AUSTIN LOARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E JACKSON ST
HUGO OK
74743-4024
US

IV. Provider business mailing address

716 SE AVENUE L
IDABEL OK
74745-7806
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-7531
  • 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 StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: