Provider Demographics
NPI:1376774042
Name:ANDERSON, CAROL JEAN (MHR, LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:ANDERSON-FURR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHR, LPC
Mailing Address - Street 1:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1282
Mailing Address - Country:US
Mailing Address - Phone:405-694-9199
Mailing Address - Fax:405-307-0333
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:SUITE 555
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4520
Practice Address - Country:US
Practice Address - Phone:405-631-4567
Practice Address - Fax:405-631-4593
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2483101YP2500X
TX16677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional