Provider Demographics
NPI:1326310897
Name:JUAREZ CARCOVICH, ISAAC (BA)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:JUAREZ CARCOVICH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N BRIARCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5657
Mailing Address - Country:US
Mailing Address - Phone:405-740-7134
Mailing Address - Fax:
Practice Address - Street 1:13504 BRAMPTON WAY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6591
Practice Address - Country:US
Practice Address - Phone:405-740-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist