Provider Demographics
NPI:1659360683
Name:WYKOFF, GEORGIA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:A
Last Name:WYKOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 S HARVARD AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6124
Mailing Address - Country:US
Mailing Address - Phone:918-744-5031
Mailing Address - Fax:918-744-5031
Practice Address - Street 1:3010 S HARVARD AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6124
Practice Address - Country:US
Practice Address - Phone:918-744-5031
Practice Address - Fax:918-744-5031
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical