Provider Demographics
NPI:1184721086
Name:ELIASON, CAROLE M (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:M
Last Name:ELIASON
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 1:110 N MERCEDES DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6468
Mailing Address - Country:US
Mailing Address - Phone:405-329-2589
Mailing Address - Fax:405-329-9219
Practice Address - Street 1:110 N MERCEDES DR
Practice Address - Street 2:SUITE 600
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6468
Practice Address - Country:US
Practice Address - Phone:405-329-2589
Practice Address - Fax:405-329-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical