Healthcare Provider Details

I. General information

NPI: 1649883885
Provider Name (Legal Business Name): ALEXIS ESTHER CARTER LMSW-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19320 E ADMIRAL PL STE B
CATOOSA OK
74015-3240
US

IV. Provider business mailing address

19320 E ADMIRAL PL STE B
CATOOSA OK
74015-3240
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-0993
  • Fax:
Mailing address:
  • Phone: 918-340-5503
  • Fax: 918-340-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7474-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: