Provider Demographics
NPI:1467755694
Name:DIACON, RACHEL LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEIGH
Last Name:DIACON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LEIGH
Other - Last Name:READ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:650 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:
Practice Address - Street 1:1055 S HOUSTON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9043
Practice Address - Country:US
Practice Address - Phone:918-921-3200
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical