Healthcare Provider Details

I. General information

NPI: 1689991085
Provider Name (Legal Business Name): CANDICE LEIGH HART M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 S LITTLE AVE APT B104
CUSHING OK
74023-4841
US

IV. Provider business mailing address

1428 S LITTLE AVE APT B104
CUSHING OK
74023-4841
US

V. Phone/Fax

Practice location:
  • Phone: 918-908-0823
  • Fax:
Mailing address:
  • Phone: 918-908-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number310698
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10615
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number108211
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: