MEDICARE: MS. PHYLLIS SUE LAMON BSW, LCSW

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	1041C0700X	Clinical Social Worker	3625	OK

General Provider Information

NPI Number	:	1376878439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS SUE LAMON BSW, LCSW

Provider Business Mailing Address
First Line	:	4118 N DREXEL BLVD APT B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6289
Country	:	US
Telephone Number	:	405-996-7600
Fax Number	:	405-601-1884

Provider Business Practice Location Address
First Line	:	4118 N DREXEL BLVD APT B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6289
Country	:	US
Telephone Number	:	405-996-7600
Fax Number	:	405-601-1884

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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