Healthcare Provider Details

I. General information

NPI: 1710206834
Provider Name (Legal Business Name): KENYA WASHINGTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21324 W GIST RD
HASKELL OK
74436-2565
US

IV. Provider business mailing address

21324 W GIST RD
HASKELL OK
74436-2565
US

V. Phone/Fax

Practice location:
  • Phone: 918-409-0815
  • Fax: 866-304-6871
Mailing address:
  • Phone: 918-409-0815
  • Fax: 866-304-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4768
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200268490A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: