Provider Demographics
NPI:1376878439
Name:LAMON, PHYLLIS SUE (BSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:SUE
Last Name:LAMON
Suffix:
Gender:F
Credentials:BSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 N DREXEL BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6289
Mailing Address - Country:US
Mailing Address - Phone:405-996-7600
Mailing Address - Fax:405-601-1884
Practice Address - Street 1:4118 N DREXEL BLVD APT B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6289
Practice Address - Country:US
Practice Address - Phone:405-996-7600
Practice Address - Fax:405-601-1884
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical