Provider Demographics
NPI:1699876623
Name:MANN, RICHARD CHARLES (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:MANN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 W BOYD ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4802
Mailing Address - Country:US
Mailing Address - Phone:405-641-0342
Mailing Address - Fax:405-307-2801
Practice Address - Street 1:1222 W BOYD ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4802
Practice Address - Country:US
Practice Address - Phone:405-641-0342
Practice Address - Fax:405-307-2801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical