Provider Demographics
NPI:1427495522
Name:LUCAS, BOBBIE DIANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:DIANE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 E 100TH ST N STE 350
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4675
Mailing Address - Country:US
Mailing Address - Phone:918-274-5510
Mailing Address - Fax:
Practice Address - Street 1:12455 E 100TH ST N STE 350
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4675
Practice Address - Country:US
Practice Address - Phone:918-274-5510
Practice Address - Fax:918-403-6312
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical