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General NPI Number Information
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NPI Number | 1760481899
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Entity Type | Organization
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Legal Business Name | STATE OF OKLAHOMA
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 602 SW 38TH STREET
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City | LAWTON
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State | OK
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Zip | 73505-6912
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Country | US
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Telephone | 580-248-5780
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Fax | 580-353-3202
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Provider Business Mailing Address
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Address Line | 602 SW 38TH STREET
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City | LAWTON
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State | OK
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Zip | 73505-6912
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Country | US
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Telephone | 580-248-5780
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Fax | 580-353-3202
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. TERRI LEE
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Credential | LPC
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Telephone | 580-250-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0005111
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 0005111
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License Number State | OK
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