Provider Demographics
NPI:1639483985
Name:WAGES, TOM B III (LCSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:B
Last Name:WAGES
Suffix:III
Gender:M
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 1:10703 E 111TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2843
Mailing Address - Country:US
Mailing Address - Phone:918-695-3336
Mailing Address - Fax:
Practice Address - Street 1:10703 E 111TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2843
Practice Address - Country:US
Practice Address - Phone:918-695-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical