Provider Demographics
NPI:1841422920
Name:MACHA, WENDY KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KAY
Last Name:MACHA
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 1:1515 E 71ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5041
Mailing Address - Country:US
Mailing Address - Phone:918-551-6879
Mailing Address - Fax:
Practice Address - Street 1:1515 E 71ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5041
Practice Address - Country:US
Practice Address - Phone:918-551-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker