Organization
STATE OF OKLAHOMA
Active
Parent organization
STATE OF OKLAHOMA DEPARTMENT OF MENTAL HEALTH
Other names
JIM TALIAFERRO CMHC
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF OKLAHOMA DEPARTMENT OF MENTAL HEALTH
Authorized official
MRS. TERRI LEE LPC (EXECUTIVE DIRECTOR)
(580) 250-2640
Entity
Organization
Contact information
Practice address
602 SW 38TH STREET, LAWTON, OK 73505-6912
(580) 248-5780
(580) 353-3202
Mailing address
602 SW 38TH STREET, LAWTON, OK 73505-6912
(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
261QM2500X
Medical Specialty Clinic/Center
0005111
OK
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100677270A
—
OK
05
—
100688870A
—
OK
05
—
100755860A
—
OK
01
—
WCDLG
MEDICARE PART B PROVIDER NUMBER
OK
Enumeration date
02/20/2007
Last updated
01/30/2024
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