Provider Demographics
NPI:1730199167
Name:EDMONDSON, CONNIE C (MSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:C
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 BROADWAY EXT
Mailing Address - Street 2:STE 320
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9037
Mailing Address - Country:US
Mailing Address - Phone:405-843-1551
Mailing Address - Fax:405-843-1494
Practice Address - Street 1:6801 BROADWAY EXT
Practice Address - Street 2:STE 320
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9037
Practice Address - Country:US
Practice Address - Phone:405-843-1551
Practice Address - Fax:405-843-1494
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health