Healthcare Provider Details

I. General information

NPI: 1467655381
Provider Name (Legal Business Name): CASEY JON HUCKS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CASINO AVE BENEFITS DEPT
THACKERVILLE OK
73459
US

IV. Provider business mailing address

210 E MAIN RESOURCE MANAGEMENT
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 580-272-5170
  • Fax: 580-421-8772
Mailing address:
  • Phone: 580-436-7211
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2265
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2268
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: