Organization
STATE OF OKLAHOMA
Active
Organization
STATE OF OKLAHOMA
Active
Other names
JIM TALIAFERRO COMMUNITY MENTAL HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MS. 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
2084P0800X
Psychiatry Physician
0005111
OK
283Q00000X
Psychiatric Hospital
Primary
0005111
OK
283Q00000X
Psychiatric Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100677270A
—
OK
05
—
100688870A
—
OK
05
—
100700660A
—
OK
05
—
100706940L
—
OK
05
—
1007558860A
—
OK
Enumeration date
07/20/2005
Last updated
01/30/2024
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