Provider Demographics
NPI:1568676708
Name:HOGAN, CANDIS JEAN (LPC, NCSP)
Entity Type:Individual
Prefix:DR
First Name:CANDIS
Middle Name:JEAN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LPC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13672 HUMMINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7153
Mailing Address - Country:US
Mailing Address - Phone:405-819-9063
Mailing Address - Fax:405-285-5210
Practice Address - Street 1:2000 E 15TH ST
Practice Address - Street 2:SUITE 150-C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6697
Practice Address - Country:US
Practice Address - Phone:405-819-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK286101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor