Healthcare Provider Details

I. General information

NPI: 1073512067
Provider Name (Legal Business Name): SHIRLEY GODFREY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 SW 38TH ST
LAWTON OK
73505-6912
US

IV. Provider business mailing address

602 SW 38TH ST
LAWTON OK
73505-6912
US

V. Phone/Fax

Practice location:
  • Phone: 580-248-5780
  • Fax: 580-248-3610
Mailing address:
  • Phone: 580-248-5780
  • Fax: 580-248-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1193
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: