Provider Demographics
NPI:1952682544
Name:DOYLE, ALICE MARY LAEGER (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MARY LAEGER
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:MARY
Other - Last Name:LAEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3525 S ZUNIS CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2711
Mailing Address - Country:US
Mailing Address - Phone:918-808-3171
Mailing Address - Fax:
Practice Address - Street 1:10159 E 11TH ST,
Practice Address - Street 2:JACK C MONTGOMERY VAMC, TULSA OUTPATIENT CLINIC STE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-6520
Practice Address - Country:US
Practice Address - Phone:918-610-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical