Provider Demographics
NPI:1780791186
Name:KOONCE, TRINA G (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:TRINA
Middle Name:G
Last Name:KOONCE
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107
Mailing Address - Country:US
Mailing Address - Phone:405-470-0477
Mailing Address - Fax:405-470-0477
Practice Address - Street 1:3710 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-470-0477
Practice Address - Fax:405-470-0477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical