Provider Demographics
NPI:1407003817
Name:VAUGHN-CASTOR, KIRSTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:VAUGHN-CASTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRSTY
Other - Middle Name:
Other - Last Name:VAUGHN-CASTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6418 N SANTA FE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9100
Mailing Address - Country:US
Mailing Address - Phone:405-242-2242
Mailing Address - Fax:405-286-1730
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:405-923-4382
Practice Address - Fax:405-631-4593
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical