Individual
LORI KIM CHILDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW-P
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-0242
Mailing address
2214 S INDIANWOOD AVE, BROKEN ARROW, OK 74012-0935
(918) 348-6776
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6099-P
OK
Other
Enumeration date
10/09/2017
Last updated
10/09/2017
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