Provider Demographics
NPI:1639573272
Name:WHITEHEAD, SARA (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:RISINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3000 UNITED FOUNDERS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4294
Mailing Address - Country:US
Mailing Address - Phone:801-891-3960
Mailing Address - Fax:405-286-0178
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD
Practice Address - Street 2:STE 208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4294
Practice Address - Country:US
Practice Address - Phone:801-891-3960
Practice Address - Fax:405-286-0178
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical