Provider Demographics
NPI:1851687867
Name:EFFINGER, SHERRIE DIANNA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:SHERRIE
Middle Name:DIANNA
Last Name:EFFINGER
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-0010
Mailing Address - Country:US
Mailing Address - Phone:405-256-5996
Mailing Address - Fax:405-265-2553
Practice Address - Street 1:110 S 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2658
Practice Address - Country:US
Practice Address - Phone:405-256-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4535101YA0400X, 1041C0700X
MO20210448981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200393610AMedicaid