Provider Demographics
NPI:1639537392
Name:RANSOM, CASSIE VANN (LADC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:VANN
Last Name:RANSOM
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:VANN
Other - Last Name:WORTHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5104
Practice Address - Country:US
Practice Address - Phone:405-425-0428
Practice Address - Fax:405-419-3042
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCANDIDATE101YA0400X
OK1358101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)