Provider Demographics
NPI:1942403126
Name:MEAD, CHRISTY DIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DIANNE
Last Name:MEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:DIANNE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723-2100
Mailing Address - Country:US
Mailing Address - Phone:417-476-1000
Mailing Address - Fax:417-476-1082
Practice Address - Street 1:2325 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-991-6500
Practice Address - Fax:918-991-6509
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical