MEDICARE: ALYSSA PAIGE CASTLES LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	5565	OK

General Provider Information

NPI Number	:	1336625417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA PAIGE CASTLES LMSW

Provider Business Mailing Address
First Line	:	PO BOX 30589
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73140-3589
Country	:	US
Telephone Number	:	405-769-3301
Fax Number	:	405-769-9685

Provider Business Practice Location Address
First Line	:	105 E. SANTA FE AVENUE
Second Line	:
City	:	CARNEY
State	:	OK
Zip	:	74832
Country	:	US
Telephone Number	:	405-769-1300
Fax Number	:	405-865-2323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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Directions to “ ALYSSA PAIGE CASTLES LMSW” Practice Location

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