Provider Demographics
NPI:1073627659
Name:BENITA W ERWIN LCSW INC PC
Entity Type:Organization
Organization Name:BENITA W ERWIN LCSW INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:580-436-7120
Mailing Address - Street 1:14537 COUNTY ROAD 3510
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2711
Mailing Address - Country:US
Mailing Address - Phone:580-436-7120
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1048
Practice Address - Country:US
Practice Address - Phone:580-436-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK441743622003OtherBLUE CROSS BLUE SHIELD