Provider Demographics
NPI:1386021764
Name:ANDERSON, GENEVIEVE (LCSW)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:ANDERSON
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 1:748 DANA DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1049
Mailing Address - Country:US
Mailing Address - Phone:904-338-2176
Mailing Address - Fax:405-702-9031
Practice Address - Street 1:3838 NW 36TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2916
Practice Address - Country:US
Practice Address - Phone:405-702-9032
Practice Address - Fax:405-702-9031
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health