Healthcare Provider Details

I. General information

NPI: 1427393669
Provider Name (Legal Business Name): VICTORIA D MCDANIEL-TRACY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9753 N 52ND WEST AVE
SPERRY OK
74073-4032
US

IV. Provider business mailing address

9753 N 52ND WEST AVE
SPERRY OK
74073-4032
US

V. Phone/Fax

Practice location:
  • Phone: 918-949-5965
  • Fax:
Mailing address:
  • Phone: 918-949-5965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4834
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: