Healthcare Provider Details

I. General information

NPI: 1760071203
Provider Name (Legal Business Name): CHARLENE BEAVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 NE LAWRIE TATUM RD
LAWTON OK
73507-3099
US

IV. Provider business mailing address

1515 NE LAWRIE TATUM RD
LAWTON OK
73507-3099
US

V. Phone/Fax

Practice location:
  • Phone: 580-354-5120
  • Fax: 580-354-5125
Mailing address:
  • Phone: 580-354-5120
  • Fax: 580-354-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7364
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: