Provider Demographics
NPI:1285757823
Name:SAWYER, DAVID RAY (EDD, LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAY
Last Name:SAWYER
Suffix:
Gender:M
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27375 S 4520 RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:OK
Mailing Address - Zip Code:74331-6179
Mailing Address - Country:US
Mailing Address - Phone:918-540-7458
Mailing Address - Fax:918-540-7745
Practice Address - Street 1:207 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6818
Practice Address - Country:US
Practice Address - Phone:918-540-7458
Practice Address - Fax:918-540-7745
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional