Healthcare Provider Details

I. General information

NPI: 1285373779
Provider Name (Legal Business Name): CASEY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST STE LL
TULSA OK
74135-5018
US

IV. Provider business mailing address

105 N HUSBAND ST
STILLWATER OK
74075-7708
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number900380
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: