Healthcare Provider Details

I. General information

NPI: 1356286157
Provider Name (Legal Business Name): LISA SEABRIDGE, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 EL CAMINO ST
PONCA CITY OK
74604-3804
US

IV. Provider business mailing address

1705 EL CAMINO ST
PONCA CITY OK
74604-3804
US

V. Phone/Fax

Practice location:
  • Phone: 580-401-2054
  • Fax: 580-401-2054
Mailing address:
  • Phone: 580-401-2054
  • Fax: 580-401-2054

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: LISA ANN SEABRIDGE
Title or Position: OWNER
Credential: LCSW
Phone: 580-401-2054