Provider Demographics
NPI:1699130369
Name:VINSON, CALEB SETH (MS LPC)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:SETH
Last Name:VINSON
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:CALEB
Other - Middle Name:SETH
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC
Mailing Address - Street 1:901 DOLLINS ST
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3205
Mailing Address - Country:US
Mailing Address - Phone:918-917-3997
Mailing Address - Fax:
Practice Address - Street 1:901 DOLLINS ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3205
Practice Address - Country:US
Practice Address - Phone:918-917-3997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
OK7102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator