Provider Demographics
NPI:1699917450
Name:CALDWELL, ALICE L (LBP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:L
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 SW 1060TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-6746
Mailing Address - Country:US
Mailing Address - Phone:918-916-9213
Mailing Address - Fax:918-465-0300
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4415
Practice Address - Country:US
Practice Address - Phone:918-465-0300
Practice Address - Fax:918-465-0300
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional