Provider Demographics
NPI:1023102928
Name:DUNCKLEE, ELIZABETH ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:DUNCKLEE
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 1:550 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-382-1229
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-382-1229
Practice Address - Fax:918-582-6405
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1042545OtherGROUP COMMUNITY CARE OF OKLAHOMA
OK731042545001OtherGROUP TRICARE
OK73-1042545OtherGROUP MEDICARE
OK100732910-AOtherGROUP MEDICAID/SOONERCARE
OK73-1042545OtherGROUP BCBS
OK100732910-GOtherGROUP MEDICAID/SOONERCARE