NPIMap

Organization Active NPI

Camelot Community Services of Oklahoma, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Broken Bow, OK
National Provider Identifier
1699838565
Registry record updated Nov 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CAMELOT COMMUNITY SERVICES OF OKLAHOMA, LLC
Practice address
100 N Broadway St
Broken Bow, OK 74728-3934
Phone
(580) 584-6054
NPI assigned
Dec 19, 2006
Last updated
Nov 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Derrel Levy, LPCNPI 1134324353
Title
Exec Dir
Phone
(580) 298-2830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

100 N Broadway St
Broken Bow, OK 74728-3934

Mailing address

4207 E Highway 290
Dripping Springs, TX 78620-4206

Other identifiers 1

IdentifierTypeStateIssuer
100744370DMedicaidOK

Other names 1

  • Counseling Center of SE Oklahoma Other name

National Provider Directory

National Provider Directory
Tax ID family
Camelot Community Services of Oklahoma LLC36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258502400000",
    "number": "1699838565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 E HIGHWAY 290",
            "city": "DRIPPING SPRINGS",
            "state": "TX",
            "postal_code": "786204206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N BROADWAY ST",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747283934",
            "telephone_number": "580-584-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT COMMUNITY SERVICES OF OKLAHOMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2009-11-18",
        "status": "A",
        "authorized_official_last_name": "LEVY",
        "authorized_official_first_name": "DERREL",
        "authorized_official_title_or_position": "EXEC DIR",
        "authorized_official_telephone_number": "580-298-2830",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100744370D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Counseling Center of SE Oklahoma",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Broken Bow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.