Individual
GRACE BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW-P
Contact information
Practice address
1116 N MAIN ST STE M12, ALTUS, OK 73521-3149
(580) 925-0325
Mailing address
605 HAYES ST, ALTUS, OK 73521-4761
(509) 703-0059
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61115510
WA
101YM0800X
Mental Health Counselor
Primary
—
OK
106S00000X
Behavior Technician
—
—
376K00000X
Nurse's Aide
NA60411306
WA
390200000X
Student in an Organized Health Care Education/Training Program
CG61115510
WA
Other
Enumeration date
05/13/2019
Last updated
11/29/2022
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