Provider Demographics
NPI:1689757270
Name:VINK-CODY, PAULA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VINK-CODY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:VINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-540-7434
Mailing Address - Fax:918-540-7533
Practice Address - Street 1:200 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6830
Practice Address - Country:US
Practice Address - Phone:918-540-7434
Practice Address - Fax:918-540-7533
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK299145YKW9Medicare PIN
OK249705801Medicare PIN
OK900522214Medicare PIN
OKP00452935OtherRR MEDICARE