Provider Demographics
NPI:1063723203
Name:MASSEY, BETH A (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N SAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-2628
Mailing Address - Country:US
Mailing Address - Phone:580-623-9191
Mailing Address - Fax:
Practice Address - Street 1:115 E 1ST ST
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3817
Practice Address - Country:US
Practice Address - Phone:580-623-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health