Provider Demographics
NPI:1053507673
Name:FEARS, JUDITH NANCY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:NANCY
Last Name:FEARS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3909 BELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3622
Mailing Address - Country:US
Mailing Address - Phone:405-631-2593
Mailing Address - Fax:405-631-2607
Practice Address - Street 1:1145 S.W. 74TH
Practice Address - Street 2:SUITE E-201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-631-2593
Practice Address - Fax:405-631-2607
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK02421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical