Provider Demographics
NPI:1326079930
Name:CROCKETT, RITA AGNES (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:AGNES
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3133
Mailing Address - Country:US
Mailing Address - Phone:405-850-5149
Mailing Address - Fax:405-946-7278
Practice Address - Street 1:5228 CLASSEN CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4429
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:405-840-9017
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32101YA0400X
OK1898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)