Individual
CASEY L NORTHCUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHRS
Contact information
Practice address
121 E MAIN ST, SUITE 101, DAVIS, OK 73030-1973
(580) 369-5080
(580) 369-2488
Mailing address
12619 COUNTY ROAD 3520, ADA, OK 74820-1711
(580) 320-5657
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
11/14/2011
Last updated
11/14/2011
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