Provider Demographics
NPI:1760508139
Name:MOXLEY, KATHY FAHL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:FAHL
Last Name:MOXLEY
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 1:3908 WESTERN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5123
Mailing Address - Country:US
Mailing Address - Phone:405-364-1420
Mailing Address - Fax:
Practice Address - Street 1:1151 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5331
Practice Address - Country:US
Practice Address - Phone:405-364-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3354P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical