Basic Information
| Provider Information | |||||||||
| NPI: | 1477809713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | BETSY | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13224 CEDAR TRL | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731311832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054744374 | ||||||||
| FaxNumber: | 4053410185 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 W GRAY ST | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730697129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059196821 | ||||||||
| FaxNumber: | 4053601616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 07/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.