Healthcare Provider Details

I. General information

NPI: 1710035167
Provider Name (Legal Business Name): BENJAMIN CLAY LANGLEY L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 2ND ST
SAND SPRINGS OK
74063-7633
US

IV. Provider business mailing address

20 W 2ND ST
SAND SPRINGS OK
74063-7633
US

V. Phone/Fax

Practice location:
  • Phone: 918-245-2344
  • Fax:
Mailing address:
  • Phone: 918-245-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0360
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: