Provider Demographics
NPI:1972790780
Name:M. RACHELLE HARDIN-MONIZ,L.C.S.W.,P.C.
Entity Type:Organization
Organization Name:M. RACHELLE HARDIN-MONIZ,L.C.S.W.,P.C.
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:HARDIN-MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-366-6068
Mailing Address - Street 1:PO BOX 5423
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5423
Mailing Address - Country:US
Mailing Address - Phone:405-366-6068
Mailing Address - Fax:405-366-6281
Practice Address - Street 1:2420 SPRINGER DR
Practice Address - Street 2:SUITE 215
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3965
Practice Address - Country:US
Practice Address - Phone:405-366-6068
Practice Address - Fax:405-366-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200105400AMedicaid