Provider Demographics
NPI:1407440415
Name:SAXON, LISA DAWN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:SAXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:SOUTHERLAND SAXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3420 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1639
Mailing Address - Country:US
Mailing Address - Phone:405-640-0163
Mailing Address - Fax:
Practice Address - Street 1:3420 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-1639
Practice Address - Country:US
Practice Address - Phone:405-640-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker