Provider Demographics
NPI:1730316985
Name:EPPS, MIEKE N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIEKE
Middle Name:N
Last Name:EPPS
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 1:2514 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5107
Mailing Address - Country:US
Mailing Address - Phone:918-747-7556
Mailing Address - Fax:
Practice Address - Street 1:2727 S 137TH WEST AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-5017
Practice Address - Country:US
Practice Address - Phone:918-245-0231
Practice Address - Fax:918-241-5031
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK01371041C0700X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children