Provider Demographics
NPI:1821581703
Name:HARRIS, ABBY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 521147
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-1147
Mailing Address - Country:US
Mailing Address - Phone:918-608-0380
Mailing Address - Fax:
Practice Address - Street 1:1402 N FLORENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3159
Practice Address - Country:US
Practice Address - Phone:918-608-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical