Provider Demographics
NPI:1275906596
Name:FLEETWOOD, JULIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 NE OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-1441
Mailing Address - Country:US
Mailing Address - Phone:918-906-7089
Mailing Address - Fax:
Practice Address - Street 1:1710 NE OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-1441
Practice Address - Country:US
Practice Address - Phone:918-906-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical