Provider Demographics
NPI:1497522064
Name:CARMACK, DANELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:
Last Name:CARMACK
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 1:15400 N MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9694
Mailing Address - Country:US
Mailing Address - Phone:405-209-9098
Mailing Address - Fax:
Practice Address - Street 1:1203 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4324
Practice Address - Country:US
Practice Address - Phone:405-209-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical