Provider Demographics
NPI:1619791829
Name:CARROTHERS, SAVANNAH
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:
Last Name:CARROTHERS
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 1:20838 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-6569
Mailing Address - Country:US
Mailing Address - Phone:575-415-8535
Mailing Address - Fax:
Practice Address - Street 1:15980 TRAILHEAD RD
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-5015
Practice Address - Country:US
Practice Address - Phone:405-481-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health