Healthcare Provider Details

I. General information

NPI: 1295278695
Provider Name (Legal Business Name): MITZI POPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NORTH MORGAN DRIVE
BEGGS OK
74421
US

IV. Provider business mailing address

107 NORTH MORGAN DRIVE
BEGGS OK
74421
US

V. Phone/Fax

Practice location:
  • Phone: 918-978-0037
  • Fax:
Mailing address:
  • Phone: 918-224-9307
  • Fax: 918-758-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7016
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: