Provider Demographics
NPI:1588936439
Name:WILLIAMS, SANDRA BARNES
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:BARNES
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 702471
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-2471
Mailing Address - Country:US
Mailing Address - Phone:918-894-9904
Mailing Address - Fax:
Practice Address - Street 1:750 N CHEROKEE STREET
Practice Address - Street 2:SUITE N
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015
Practice Address - Country:US
Practice Address - Phone:918-894-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker