Provider Demographics
NPI:1912235185
Name:LEVENIA MARIE CAREY
Entity Type:Organization
Organization Name:LEVENIA MARIE CAREY
Other - Org Name:CHILDREN, ADOLESCENT AND FAMILY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEVENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MED/MSW/LPC
Authorized Official - Phone:918-429-8184
Mailing Address - Street 1:1019 KINKEAD RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7704
Mailing Address - Country:US
Mailing Address - Phone:918-429-8184
Mailing Address - Fax:918-426-5439
Practice Address - Street 1:1019 KINKEAD RD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7704
Practice Address - Country:US
Practice Address - Phone:918-429-8184
Practice Address - Fax:918-426-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200266780BMedicaid
OK200266780AMedicaid