CAMELOT COMMUNITY SERVICES OF OKLAHOMA, LLC (NPI# 1417011081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417011081 |
| Entity Type | Organization |
| Organization Name | CAMELOT COMMUNITY SERVICES OF OKLAHOMA, LLC |
| Other Organization Name | COUNSELING CENTER OF SE OKLAHOMA |
| Practice Address |
2816 E Jackson St Suite C Hugo OK 74743-4250 |
| Mailing Address |
4207 E Highway 290 Dripping Springs TX 78620-4206 |
| Practice Telephone | 5803265350 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2009-11-18 |
| Authorized Official Name | DERREL LEVY (EXEC DIR) |
| Authorized Official Telephone | 5802982830 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100744370G | 05 |
| Other Name | Type Code |
|---|---|
| Counseling Center of SE Oklahoma | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699838565 | Camelot Community Services of Oklahoma, LLC | Clinic/Center | 100 N Broadway St, Broken Bow, OK 74728-3934 | 2006-12-19 |
| Street Address |
2816 E JACKSON ST SUITE C |
| City | HUGO |
| State | OK |
| Zip Code | 74743-4250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215462247 | Courtney Wilder | Health Educator | 2816 E Jackson St, Suite C, Hugo, OK 74743-4250 | 2017-04-27 |
| 1982943379 | Julia Ann Mason | Counselor | 2816 E Jackson St, Hugo, OK 74743-4250 | 2013-02-05 |
| 1316285430 | Olivia Jent | Counselor | 2816 E Jackson St, Hugo, OK 74743-4250 | 2013-01-24 |
| 1457674475 | Kimberly R Anderson | Psychologist | 2816 E Jackson St, Hugo, OK 74743-4250 | 2010-03-04 |
| 1497919922 | Jennifer Dyer | Psychologist | 2816 E Jackson St, Hugo, OK 74743-4250 | 2008-07-14 |
| 1073775854 | Sequelcare of Oklahoma, LLC | Community/Behavioral Health | 2816 E Jackson St, Suite C, Hugo, OK 74743-4250 | 2008-07-02 |
| 1801086236 | Kristianna Beddo | Counselor | 2816 E Jackson St, Hugo, OK 74743-4250 | 2007-08-01 |
| 1336358134 | Heide Grant | Counselor | 2816 E Jackson St, Suite C, Hugo, OK 74743-4250 | 2007-05-21 |
| 1639233703 | Sequelcare of Oklahoma, LLC | Clinic/Center | 2816 E Jackson St, Suite C, Hugo, OK 74743-4250 | 2006-12-21 |
| 1457415523 | Sequelcare of Oklahoma, LLC | Case Management | 2816 E Jackson St, Suite C, Hugo, OK 74743-4250 | 2006-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053817775 | Emilia Sue Lopez | Registered Nurse | 2008 East 2110 Road, Hugo, OK 74743 | 2018-04-02 |
| 1144739657 | Healing Hearts Counseling & Consulting, L.L.C. | Clinic/Center | 1212 East Kirk, Hugo, OK 74743 | 2017-09-27 |
| 1457801177 | Kelli Lemke | Nurse Practitioner | 204 E. Jackson St., Hugo, OK 74743 | 2016-10-05 |
| 1780040147 | Shabreka Dorshell Coleman | Student in an Organized Health Care Education/Training Program | 1475 North 4220 Road, Grant, OK 74743 | 2016-01-14 |
| 1063898161 | Jaclyn Deann Rouse | Optometrist | 410 North M Street, Hugo, OK 74743 | 2015-07-31 |
| 1548519648 | Tori L Fowler | Counselor | 112 W. Jackson, Hugo, OK 74743 | 2012-09-05 |
| 1174802219 | Malinda Burnett | Counselor | 1100 David Roebuck Lane, Hugo, OK 74743 | 2011-08-08 |
| 1942591490 | Joshua Asher Tims | Clinic/Center | 1213 E. Jackson St, Hugo, OK 74743 | 2011-05-02 |
| 1598998320 | Kimberly Dawn Jones | Social Worker | 1717 1/2 West Jackson, Hugo, OK 74743 | 2009-08-27 |
| 1689812547 | Adeline Youngblood | Counselor | 612 E Jackson, Hugo, OK 74743 | 2009-01-30 |
| Find all providers in zip 74743 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942591490 | Joshua Asher Tims | Clinic/Center | 1213 E. Jackson St, Hugo, OK 74743 | 2011-05-02 |
| 1003985896 | Southern Oklahoma Treatment Services, Inc. | Clinic/Center | 1213 East Jackson Street, Hugo, OK 74743 | 2006-11-07 |
| 1003243486 | Healing Hearts Counseling Center | Clinic/Center | 211 E Jackson St, Hugo, OK 74743-4036 | 2013-10-01 |
| 1164721056 | Providence Service Corp | Clinic/Center | 117 E Main St, Hugo, OK 74743-6237 | 2011-03-18 |
| 1639233703 | Sequelcare of Oklahoma, LLC | Clinic/Center | 2816 E Jackson St, Suite C, Hugo, OK 74743-4250 | 2006-12-21 |
| 1235299645 | Providence Service Corporation of Oklahoma | Clinic/Center | 117 E Main St, Hugo, OK 74743-6237 | 2006-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870742 | Sequelcare of Oklahoma, LLC | Clinic/Center | 6218 S Lewis Ave Ste 118, Tulsa, OK 74136-1018 | 2020-10-28 |
| 1649870890 | M & M Counseling Group, LLC | Clinic/Center | 207 S Czech Hall Rd, Yukon, OK 73099-6851 | 2020-10-27 |
| 1992303721 | Misty Watkins | Clinic/Center | 1601 Sw Parkridge Blvd Ste 200, Lawton, OK 73505-7564 | 2020-10-14 |
| 1295342046 | Integrative Healthcare Solutions LLC | Clinic/Center | 2227 E 8th St, Tulsa, OK 74104-3237 | 2020-09-25 |
| 1235744020 | Strength of A Warrior Counseling Services LLC | Clinic/Center | 4516 Se 25th St, Del City, OK 73115-4114 | 2020-09-09 |
| 1609488253 | Alexie Foster, LLC | Clinic/Center | 16802 S 301st West Ave, Bristow, OK 74010-2265 | 2020-08-17 |
| 1306455068 | Restore Family Counseling, LLC | Clinic/Center | 100 W. Wilshire, Suite #c3, Oklahoma City, OK 73116 | 2020-07-29 |
| 1245855857 | Dragonfly Psychotherapy | Clinic/Center | 2942 Ne Orlie Dr, Forest Park, OK 73121-2436 | 2020-06-09 |
| 1508480872 | Maria Nancy Martinez | Clinic/Center | 5350 S Western Ave Ste 217, Oklahoma City, OK 73109-4525 | 2020-06-03 |
| 1649894015 | Miranda Rackers | Clinic/Center | 1308 E Mckinley Ave, Sapulpa, OK 74066-4824 | 2020-06-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.