Healthcare Provider Details

I. General information

NPI: 1063725315
Provider Name (Legal Business Name): TINA LOUISE CAUSEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 09/15/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 HAR-BER ROAD
GROVE OK
74344-7434
US

IV. Provider business mailing address

1115 HAR-BER ROAD
GROVE OK
74344
US

V. Phone/Fax

Practice location:
  • Phone: 844-458-2100
  • Fax:
Mailing address:
  • Phone: 844-458-2100
  • Fax: 918-273-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4471
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: