Organization
CAMELOT COMMUNITY SERVICES OF OKLAHOMA, LLC
Active
Other names
Counseling Center of SE Oklahoma
Organization subpart
No
Provider details
NPI number
Authorized official
DERREL LEVY LPC (EXEC DIR)
(580) 298-2830
Entity
Organization
Contact information
Practice address
100 N BROADWAY ST, BROKEN BOW, OK 74728-3934
(580) 584-6054
Mailing address
4207 E HIGHWAY 290, DRIPPING SPRINGS, TX 78620-4206
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744370D
—
OK
Enumeration date
12/19/2006
Last updated
11/18/2009
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