Provider Demographics
NPI:1063655058
Name:HARE, ELECTA LEIGH (MSW)
Entity Type:Individual
Prefix:
First Name:ELECTA
Middle Name:LEIGH
Last Name:HARE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-4204
Mailing Address - Country:US
Mailing Address - Phone:918-287-1775
Mailing Address - Fax:918-287-3306
Practice Address - Street 1:124 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-4204
Practice Address - Country:US
Practice Address - Phone:918-287-1175
Practice Address - Fax:918-287-3306
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical