MEDICARE: MRS. MICAH JEAN GRAVES BARNETT 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	3508	OK

General Provider Information

NPI Number	:	1831322551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICAH JEAN GRAVES BARNETT LCSW

Provider Business Mailing Address
First Line	:	2806 SW 77TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-4608
Country	:	US
Telephone Number	:	405-203-6793
Fax Number	:	405-203-6793

Provider Business Practice Location Address
First Line	:	1601 SW 89TH ST STE F200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6358
Country	:	US
Telephone Number	:	405-787-0700
Fax Number	:

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

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	03/03/2015

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