Organization
JIM TALIAFERRO COMMUNITY MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY MCCUISTON BS (DIRECTOR)
(580) 248-5780
Entity
Organization
Contact information
Practice address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5780
(580) 248-3610
Mailing address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5780
(580) 248-3610
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
07/01/2011
Last updated
07/01/2011
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