Provider Demographics
NPI:1053676064
Name:HARRIS, SANDRA ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ANN
Other - Last Name:CHRISTIANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3932 S CINCINNATI AVE APT D
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3058
Mailing Address - Country:US
Mailing Address - Phone:361-548-6181
Mailing Address - Fax:
Practice Address - Street 1:3932 S CINCINNATI AVE APT D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3058
Practice Address - Country:US
Practice Address - Phone:361-548-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1447559711Medicaid