Provider Demographics
NPI:1316252976
Name:SEATON, EVELYN L (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:L
Last Name:SEATON
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROADWAY ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5135
Mailing Address - Country:US
Mailing Address - Phone:405-831-7791
Mailing Address - Fax:405-759-2944
Practice Address - Street 1:201 N BROADWAY ST
Practice Address - Street 2:SUITE 109
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5135
Practice Address - Country:US
Practice Address - Phone:405-831-7791
Practice Address - Fax:405-759-2944
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ITIN 27-3309899OtherFEDERAL TAX ID
ACSW 882101394OtherNATIONAL ASSOC OF SOCIAL WORKERS/ACADEMY OF CERTIFIED SOCIAL WORKERS