Provider Demographics
NPI:1518594290
Name:VAN HORN, LESA G (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:G
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 NW 56TH ST STE 150A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4548
Mailing Address - Country:US
Mailing Address - Phone:405-717-9840
Mailing Address - Fax:405-942-4790
Practice Address - Street 1:3525 NW 56TH ST STE 150A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4548
Practice Address - Country:US
Practice Address - Phone:405-717-9840
Practice Address - Fax:405-942-4790
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical