Provider Demographics
NPI:1457621427
Name:SCOVILLE, CALEB M
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:M
Last Name:SCOVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5105
Mailing Address - Country:US
Mailing Address - Phone:580-201-7686
Mailing Address - Fax:
Practice Address - Street 1:300 N STATE ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5105
Practice Address - Country:US
Practice Address - Phone:580-201-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional