Organization
LAWTON PSYCHIATRY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMIE BLACKBURN (MEDICAL BILLING)
(580) 357-3034
Entity
Organization
Contact information
Practice address
605 W GORE BLVD STE 1, LAWTON, OK 73501-3732
(580) 357-7332
(580) 357-7455
Mailing address
605 W GORE BLVD STE 1, LAWTON, OK 73501-3732
(580) 357-7332
(580) 357-7455
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100205610B
—
OK
05
—
200331430A
—
OK
Enumeration date
07/06/2011
Last updated
07/06/2011
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