Provider Demographics
NPI:1497942635
Name:CARGILL, OTTO ARTHUR (MFT ADC)
Entity Type:Individual
Prefix:MR
First Name:OTTO
Middle Name:ARTHUR
Last Name:CARGILL
Suffix:
Gender:M
Credentials:MFT ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 BIRKENHEAD RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7504
Mailing Address - Country:US
Mailing Address - Phone:405-205-9677
Mailing Address - Fax:
Practice Address - Street 1:7905 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9225
Practice Address - Country:US
Practice Address - Phone:405-262-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional