Provider Demographics
NPI:1437587789
Name:HART, WILLIAM JR (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HART
Suffix:JR
Gender:M
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:PO BOX 30133
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0003
Mailing Address - Country:US
Mailing Address - Phone:405-437-0014
Mailing Address - Fax:405-300-0704
Practice Address - Street 1:4200 PERIMETER CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2322
Practice Address - Country:US
Practice Address - Phone:405-437-0014
Practice Address - Fax:405-300-0704
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
OK50051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker