Organization
PROJECT IMPACT OKLAHOMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL SUE KIMBRO MS, LPC (VICE-PRESIDENT)
(580) 677-9406
Entity
Organization
Contact information
Practice address
102 N 1ST ST, MADILL, OK 73446-2202
(580) 677-9406
Mailing address
102 N 1ST ST, MADILL, OK 73446-2202
(580) 677-9406
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3839
OK
Other
Enumeration date
03/08/2011
Last updated
07/04/2011
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