Healthcare Provider Details

I. General information

NPI: 1659360683
Provider Name (Legal Business Name): GEORGIA A. WYKOFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 S HARVARD AVE SUITE 314
TULSA OK
74114-6124
US

IV. Provider business mailing address

3010 S HARVARD AVE SUITE 314
TULSA OK
74114-6124
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-5031
  • Fax: 918-744-5031
Mailing address:
  • Phone: 918-744-5031
  • Fax: 918-744-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: