Healthcare Provider Details

I. General information

NPI: 1609125293
Provider Name (Legal Business Name): JEFFERY CLINT MACKEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 12TH AVE NE
NORMAN OK
73071-5238
US

IV. Provider business mailing address

320 12TH AVE NE
NORMAN OK
73071-5238
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-3842
  • Fax:
Mailing address:
  • Phone: 405-573-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: