Basic Information
| Provider Information | |||||||||
| NPI: | 1477930634 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINDVIEW | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 202 SW 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ADAIR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743302000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188245009 | ||||||||
| FaxNumber: | 9187855659 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 SW 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ADAIR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743302000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188245009 | ||||||||
| FaxNumber: | 9187855659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2015 | ||||||||
| LastUpdateDate: | 04/27/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KILPATRICK | ||||||||
| AuthorizedOfficialFirstName: | BILLY | ||||||||
| AuthorizedOfficialMiddleName: | AL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9188245009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.