Individual
OTEASA R GIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3100 MEDICAL PKWY, CLAREMORE, OK 74017-1088
(918) 382-7300
Mailing address
904 W KENOSHA ST STE 2, BROKEN ARROW, OK 74012-8917
(918) 269-5058
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7323
OK
1041C0700X
Clinical Social Worker
Primary
8795
OK
Other
Enumeration date
04/09/2020
Last updated
02/20/2026
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