Provider Demographics
NPI:1508185430
Name:MASON, KARLY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KARLY
Middle Name:LYNN
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:LYNN
Other - Last Name:WIEMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1608 E. 35TH ST.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-810-0941
Mailing Address - Fax:
Practice Address - Street 1:2140 S. HARVARD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-747-6377
Practice Address - Fax:918-747-8594
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200382850AMedicaid
OK200382850AOtherOK DEPT. OF MENTAL HEALTH & SUB. ABUSE