Provider Demographics
NPI:1750928974
Name:LIEVANO-STANTON, MARTHA (LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LIEVANO-STANTON
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 1:6216 S LEWIS AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1077
Mailing Address - Country:US
Mailing Address - Phone:918-960-7047
Mailing Address - Fax:539-664-5738
Practice Address - Street 1:1334 N LANSING AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5907
Practice Address - Country:US
Practice Address - Phone:918-587-2171
Practice Address - Fax:918-587-4534
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical