Healthcare Provider Details

I. General information

NPI: 1720313430
Provider Name (Legal Business Name): JULIE NICOLE LIKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 S BRADEN AVE
TULSA OK
74136-6302
US

IV. Provider business mailing address

7145 S BRADEN AVE
TULSA OK
74136-6302
US

V. Phone/Fax

Practice location:
  • Phone: 918-496-9588
  • Fax:
Mailing address:
  • Phone: 918-496-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4297
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: