STATE OF OKLAHOMA (NPI# 1619012515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619012515 |
| Entity Type | Organization |
| Organization Name | STATE OF OKLAHOMA |
| Other Organization Name | JIM TALIAFERRO CMHC |
| Practice Address |
602 Sw 38th Street Lawton OK 73505-6912 |
| Practice Telephone | 5802485780 |
| Practice Fax Number | 5803533202 |
| Mailing Telephone | 5802485780 |
| Mailing Fax Number | 5803533202 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2011-06-16 |
| Authorized Official Name | MRS. BRENDA OTOTIVO (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5802485780 |
| Authorized Official Credential | LBP, LADC |
| Is Organization Subpart | Y |
| Parent Organization Name | STATE OF OKLAHOMA DEPARTMENT OF MENTAL HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
0005111 | OK | Ambulatory Health Care Facilities |
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
0005111 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100755860A | 05 | |
| OK | 100677270A | 05 | |
| OK | 100688870A | 05 | |
| OK | MEDICARE PART B PROVIDER NUMBER | WCDLG | 01 |
| Other Name | Type Code |
|---|---|
| JIM TALIAFERRO CMHC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225352057 | State of Oklahoma | Community/Behavioral Health | 400 North Oak, Taft, OK 74463 | 2010-03-23 |
| 1790922185 | State of Oklahoma | Community Based Residential Treatment Facility, Mental Illness | 2323 South Harvard, Tulsa, OK 74114 | 2009-01-07 |
| 1124286059 | State of Oklahoma | Pharmacy | 304 Fairlane Ave, Sulphur, OK 73086-6861 | 2008-05-28 |
| 1154589430 | State of Oklahoma | Skilled Nursing Facility | 10014 Se 1138th Street, Talihina, OK 74571-6028 | 2008-05-23 |
| 1225295710 | State of Oklahoma | Skilled Nursing Facility | 1701 South 4th, Clinton, OK 73601-1209 | 2008-05-21 |
| 1881872182 | State of Oklahoma | Skilled Nursing Facility | 900 E. Airport Rd., Okmulgee, OK 74447 | 2008-02-08 |
| 1720152788 | State of Oklahoma | Community/Behavioral Health | 702 N. Grand, Northwest Center for Behavioral Health, Enid, OK 73701 | 2006-11-20 |
| 1750456588 | State of Oklahoma | Community/Behavioral Health | 1222 10th Street, Suite 211, Northwest Center for Behavioral Health, Woodward, OK 73801-3156 | 2006-11-20 |
| 1700950201 | State of Oklahoma | Substance Abuse Rehabilitation Facility | 5050 Williams Avenue, Northwest Center for Behavioral Health, Woodward, OK 73801 | 2006-11-17 |
| 1922171701 | State of Oklahoma | Psychiatric Hospital | 1 Mile East U.S. Highway 270, Fort Supply, OK 73841-0001 | 2006-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STATE OF OKLAHOMA EAST CENTRAL UNIVERSITY | 1100 E 14th St, Ada, OK 74820-6999 |
| Street Address |
602 SW 38TH STREET |
| City | LAWTON |
| State | OK |
| Zip Code | 73505-6912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760481899 | State of Oklahoma | Psychiatric Hospital | 602 Sw 38th Street, Lawton, OK 73505-6912 | 2005-07-20 |
| 1750635751 | Giselle Greenidge | Counselor | 602 Sw 38th Street, Lawton, OK 73505 | 2012-10-30 |
| 1316245954 | Kim Elise Bartlett | Specialist | 602 Sw 38th Street, Lawton, OK 73505-6912 | 2011-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134744006 | Angela Janell Smith | Case Manager/Care Coordinator | 4904 Nw Smith Ave, Lawton, OK 73505 | 2020-06-16 |
| 1295383990 | Akeemia Lorene Holder | Case Manager/Care Coordinator | Youth Care of Oklahoma, 713 Sw C Avenue, OK 73505 | 2019-08-27 |
| 1225685480 | Healthstat Onsite Clinic Goodyear Vision Center | Preventive Medicine | 1 Goodyear Blvd, Lawton, OK 73505 | 2019-08-22 |
| 1891285300 | Michael Anthony Gray | Case Manager/Care Coordinator | 2218 Nw 36th St, Lawton, OK 73505 | 2018-05-10 |
| 1841797362 | Adeshola T Fatuyi | Case Manager/Care Coordinator | 7301 Sw Lee 635, Lawton, OK 73505 | 2018-04-11 |
| 1912425539 | Heather Shea Morefield | Case Manager/Care Coordinator | 2712 Sw H Ave, Lawton, OK 73505 | 2017-09-04 |
| 1972031367 | Burke Hendricks | Emergency Medicine | 3401 West Gore Boulevard, Lawton, OH 73505 | 2017-05-30 |
| 1932642279 | Helery Vance | Peer Specialist | 1420 Nw Hunter Rd Apt C7, Lawton, OK 73505 | 2016-11-18 |
| 1629523436 | Sebrina Sheppard | Case Manager/Care Coordinator | 3907 Sw Parkridge Blvd., Lawton, OK 73505 | 2016-08-22 |
| 1376913590 | David Lee Atauvich | Registered Nurse | 1515 Lawrie Rd, Lawton, OK 73505 | 2015-09-30 |
| Find all providers in zip 73505 | ||||
| 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 |
|---|---|---|---|---|
| 1992303721 | Misty Watkins | Clinic/Center | 1601 Sw Parkridge Blvd Ste 200, Lawton, OK 73505-7564 | 2020-10-14 |
| 1487289252 | Compass Counseling Services, LLC | Clinic/Center | 305 Tara Way, Lawton, IA 51030-1026 | 2020-03-11 |
| 1346750569 | The Mind, Heart & Soul Counseling Enrichment Organization, LLC | Clinic/Center | 1317 Sw Washington Ave, Lawton, OK 73501-7231 | 2017-10-02 |
| 1033279443 | Providence Service Corporation of Oklahoma | Clinic/Center | 4645 W Gore Blvd Ste 5, Lawton, OK 73505-5962 | 2006-12-08 |
| 1568027118 | Powers & Powers, Inc | Clinic/Center | 1930 Nw Ferris Ave Ste 4, Lawton, OK 73507-5629 | 2019-05-08 |
| 1194241240 | Mistie Lynn Farmer | Clinic/Center | 602 Sw 38th St, Lawton, OK 73505-6912 | 2017-08-21 |
| 1154877561 | Anthony Mans | Clinic/Center | 808 Nw 35th St, Lawton, OK 73505-5120 | 2016-08-27 |
| 1629400288 | Yco Tulsa, Inc. | Clinic/Center | 602 Sw A Ave, Lawton, OK 73501-3930 | 2013-08-06 |
| 1417059460 | Christian Family Counseling Center Inc | Clinic/Center | 5002 Sw Lee Blvd, Lawton, OK 73505 | 2006-09-01 |
| 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 |
| 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 |
| 1144842923 | Forth Star Counseling LLC | Clinic/Center | 5350 S Western Ave Ste 731, Oklahoma City, OK 73109-4520 | 2020-05-14 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on STATE OF OKLAHOMA.
| 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.