Healthcare Provider Details

I. General information

NPI: 1457535486
Provider Name (Legal Business Name): AVA HAMILTON CAUGHREAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 S LEWIS AVE STE 1000
TULSA OK
74136-1088
US

IV. Provider business mailing address

6926 E 72ND ST
TULSA OK
74133-2742
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-7223
  • Fax: 918-744-7240
Mailing address:
  • Phone: 918-744-7224
  • Fax: 918-744-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3287
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: