Provider Demographics
NPI:1518135169
Name:COON, BEVERLY DIANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:DIANE
Last Name:COON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BEVERLY
Other - Middle Name:DIANE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 S WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OK
Mailing Address - Zip Code:73007-6913
Mailing Address - Country:US
Mailing Address - Phone:405-640-6306
Mailing Address - Fax:
Practice Address - Street 1:821 S WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:OK
Practice Address - Zip Code:73007-6913
Practice Address - Country:US
Practice Address - Phone:405-640-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health