Organization
JIM TALIAFERRO CMHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA OTOTIVO LBP, LADC (EXECUTIVE DIRECTOR)
(580) 248-5780
Entity
Organization
Contact information
Practice address
110 SE 2ND STREET, ANADARKO, OK 73005-3416
(580) 248-5780
(580) 353-3202
Mailing address
110 SE 2ND STREET, ANADARKO, OK 73005-3416
(580) 248-5780
(580) 353-3202
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0005111
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100706940D
—
OK
05
—
100706940I
—
OK
Enumeration date
02/20/2007
Last updated
06/16/2011
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