Provider Demographics
NPI:1144593740
Name:JUDITH N FEARS, LCSW, PLLC
Entity type:Organization
Organization Name:JUDITH N FEARS, LCSW, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:FEARS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-290-1436
Mailing Address - Street 1:1800 N INTERSTATE DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2993
Mailing Address - Country:US
Mailing Address - Phone:405-290-1436
Mailing Address - Fax:
Practice Address - Street 1:1800 N INTERSTATE DR
Practice Address - Street 2:SUITE 116
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2993
Practice Address - Country:US
Practice Address - Phone:405-290-1436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty