MEDICARE: KATIE BOATENG 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	101YM0800X	Mental Health Counselor	9060	OK
2	1041C0700X	Clinical Social Worker	9060	OK

General Provider Information

NPI Number	:	1831889807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BOATENG LCSW

Provider Business Mailing Address
First Line	:	215 W MCARTHUR DR APT 68
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-5563
Country	:	US
Telephone Number	:	405-200-9479
Fax Number	:

Provider Business Practice Location Address
First Line	:	8855 E RENO AVE STE 200
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7724
Country	:	US
Telephone Number	:	405-200-9479
Fax Number	:

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

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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Directions to “ KATIE BOATENG LCSW” Practice Location

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