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General NPI Number Information
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NPI Number | 1407128572
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Entity Type | Organization
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Legal Business Name | KICKAPOO HEALTH CENTER
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 105365 S.HIGHWAY 102
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City | MCLOUD
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State | OK
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Zip | 74851
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Country | US
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Telephone | 405-964-2618
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1059
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City | MCLOUD
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State | OK
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Zip | 74851-1059
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | CHRISTINE S. MCKINNEY
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Credential | BACHELORS DEGREE
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Telephone | 405-964-2618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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