MEDICARE: EVELYN L SEATON MSW, LCSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2961	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ITIN 27-3309899	OTHER		FEDERAL TAX ID
2	ACSW 882101394	OTHER		NATIONAL ASSOC OF SOCIAL WORKERS/ACADEMY OF CERTIFIED SOCIAL WORKERS

General Provider Information

NPI Number	:	1316252976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN L SEATON MSW, LCSW, ACSW

Provider Business Mailing Address
First Line	:	201 N BROADWAY ST
Second Line	:	SUITE 109
City	:	MOORE
State	:	OK
Zip	:	73160-5135
Country	:	US
Telephone Number	:	405-831-7791
Fax Number	:	405-759-2944

Provider Business Practice Location Address
First Line	:	201 N BROADWAY ST
Second Line	:	SUITE 109
City	:	MOORE
State	:	OK
Zip	:	73160-5135
Country	:	US
Telephone Number	:	405-831-7791
Fax Number	:	405-759-2944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	05/20/2011

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