Healthcare Provider Details

I. General information

NPI: 1124253562
Provider Name (Legal Business Name): ELIZABETH EVANS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 NW 21ST ST
OKLAHOMA CITY OK
73103-1809
US

IV. Provider business mailing address

8121 NATIONAL AVE STE 401
MIDWEST CITY OK
73110-7572
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-7724
  • Fax: 405-528-0394
Mailing address:
  • Phone: 405-733-5437
  • Fax: 405-732-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: