NPIMap

Organization Active NPI

Life Psychiatric Clinic Clinton LLC

Doing business as Life Psychiatric Clinic

  • Psychiatry Physician
  • Clinton, OK
National Provider Identifier
1871382598
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LIFE PSYCHIATRIC CLINIC CLINTON LLC
Doing business as
Life Psychiatric Clinic
Practice address
545 S 30TH Street
Clinton, OK 73601
Phone
(580) 547-4087
NPI assigned
May 1, 2025
Last updated
May 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Authorized official

Name
Mebin Babu Thomas, PA-CNPI 1598082737
Title
Member
Phone
(405) 414-9139

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

545 S 30TH Street
Clinton, OK 73601

Mailing address

609 S Kelly Ave Ste B2
Edmond, OK 73003-5725

Other names 1

  • Life Psychiatric Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250930002602 OK Part B Supplier - Clinic/Group Practice 4486150364 Receives reassigned benefits from 3 practitioners
Practice locations: Clinton, OK

National Provider Directory

National Provider Directory

Locations

545 S 30th St
Clinton, OK 73601
Phone (580) 547-4087

609 S Kelly Ave
Ste B2
Edmond, OK 73003
Phone (405) 724-6871

Practitioners & affiliated clinicians

Practitioners 5

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": "1746057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1871382598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 S KELLY AVE STE B2",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730035725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 S 30TH STREET",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "73601",
            "telephone_number": "580-547-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE PSYCHIATRIC CLINIC CLINTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-01",
        "last_updated": "2025-05-01",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MEBIN",
        "authorized_official_middle_name": "BABU",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "405-414-9139",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Psychiatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.