Provider Demographics
NPI:1194026567
Name:TOWNSEND-WELLONS, SALLY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:TOWNSEND-WELLONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:OXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6216 S LEWIS AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1077
Mailing Address - Country:US
Mailing Address - Phone:918-960-7852
Mailing Address - Fax:539-664-5738
Practice Address - Street 1:304 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4640
Practice Address - Country:US
Practice Address - Phone:918-268-7295
Practice Address - Fax:539-664-5738
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53671041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200369760 BMedicaid