Provider Demographics
NPI:1326240060
Name:MARLETT-CAMPBELL, DEBRA KAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAYE
Last Name:MARLETT-CAMPBELL
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:PO BOX 365
Mailing Address - Street 2:709 S. MAIN
Mailing Address - City:CUSTER CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73639
Mailing Address - Country:US
Mailing Address - Phone:580-593-2224
Mailing Address - Fax:
Practice Address - Street 1:70 N 31ST ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9116
Practice Address - Country:US
Practice Address - Phone:580-323-5635
Practice Address - Fax:580-323-5635
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK#3741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical