Provider Demographics
NPI:1174028948
Name:MASTIN, CAILEY BREANNA (LCSW)
Entity type:Individual
Prefix:
First Name:CAILEY
Middle Name:BREANNA
Last Name:MASTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAILEY
Other - Middle Name:BREANNA
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:221 SW 141ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7249
Mailing Address - Country:US
Mailing Address - Phone:918-916-9609
Mailing Address - Fax:
Practice Address - Street 1:620 NW 5TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3947
Practice Address - Country:US
Practice Address - Phone:405-208-4469
Practice Address - Fax:405-208-4472
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical