Provider Demographics
NPI:1881909075
Name:TRIMBLE, CASEY MAE
Entity type:Individual
Prefix:MISS
First Name:CASEY
Middle Name:MAE
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MAE
Other - Last Name:VANMATRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67009 E 261 RD
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6118
Mailing Address - Country:US
Mailing Address - Phone:918-857-1812
Mailing Address - Fax:
Practice Address - Street 1:1115 HARBOR RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3505
Practice Address - Country:US
Practice Address - Phone:918-857-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101Y00000XMedicaid