Provider Demographics
NPI:1568666857
Name:FLETCHER, ELIZABETH JOY (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOY
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:JOY
Other - Last Name:FLETCHER-BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4604 NW 33RD TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-1328
Mailing Address - Country:US
Mailing Address - Phone:405-761-2514
Mailing Address - Fax:405-213-0927
Practice Address - Street 1:4019 N CLASSEN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2639
Practice Address - Country:US
Practice Address - Phone:405-761-2514
Practice Address - Fax:405-213-0927
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK38711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK273935YPW6Medicare PIN
OKOK404917Medicare PIN