=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184721086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLE M ELIASON L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N MERCEDES DR SUITE 600
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-329-2589
-----------------------------------------------------
Fax | 405-329-9219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N MERCEDES DR SUITE 600
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-329-2589
-----------------------------------------------------
Fax | 405-329-9219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 136
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------