Provider Demographics
NPI:1770815086
Name:HILDESTAD, CASEY JAMES (LPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JAMES
Last Name:HILDESTAD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 E 46TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2926
Mailing Address - Country:US
Mailing Address - Phone:918-591-2510
Mailing Address - Fax:
Practice Address - Street 1:3314 E 46TH ST STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2926
Practice Address - Country:US
Practice Address - Phone:918-591-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional