Healthcare Provider Details

I. General information

NPI: 1689092850
Provider Name (Legal Business Name): CASSANDRA SEWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17408 DURBIN PARK RD
EDMOND OK
73012-6912
US

IV. Provider business mailing address

17408 DURBIN PARK RD
EDMOND OK
73012-6912
US

V. Phone/Fax

Practice location:
  • Phone: 405-642-0646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: