Provider Demographics
NPI:1780958439
Name:SICARD, JOE ANNA (BHRS)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:ANNA
Last Name:SICARD
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:ANNA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1924 CEDAR POINTE LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2466
Mailing Address - Country:US
Mailing Address - Phone:405-248-0360
Mailing Address - Fax:
Practice Address - Street 1:1924 CEDAR POINTE LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2466
Practice Address - Country:US
Practice Address - Phone:405-248-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation