Provider Demographics
NPI:1649982489
Name:FOXWORTH, SHERIDAN NICOLE RAY (MS)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:NICOLE RAY
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHERIDAN
Other - Middle Name:NICOLE
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:710 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-3930
Mailing Address - Country:US
Mailing Address - Phone:918-691-8017
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPCCANDIDATE11449101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor