Healthcare Provider Details

I. General information

NPI: 1164154761
Provider Name (Legal Business Name): EMILY C SKIDMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 S WALKER AVE
OKLAHOMA CITY OK
73139-7026
US

IV. Provider business mailing address

6100 S WALKER AVE
OKLAHOMA CITY OK
73139-7026
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFTCANDIDATE13165
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMFTCANDIDATE13165
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: