=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750657474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY CARE OF OKLAHOMA MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2012
-----------------------------------------------------
Last Update Date | 03/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E. COURT ST
-----------------------------------------------------
City | ATOKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74525-2047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-889-2400
-----------------------------------------------------
Fax | 580-889-2401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 E. COURT
-----------------------------------------------------
City | ATOKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-889-2400
-----------------------------------------------------
Fax | 580-889-2401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MRS. KIMBERLY L. BAUGHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-916-1263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------