Healthcare Provider Details

I. General information

NPI: 1356719660
Provider Name (Legal Business Name): CANDICE JOY CRAIG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDICE JOY HAPPACH LCSW

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 03/28/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10831 HARRISON
BEGGS OK
74421
US

IV. Provider business mailing address

7521 S OLYMPIA AVE # 1021
TULSA OK
74132-1855
US

V. Phone/Fax

Practice location:
  • Phone: 918-322-1214
  • Fax:
Mailing address:
  • Phone: 918-322-1214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: