Provider Demographics
NPI:1730273178
Name:HOOVER, VINNIE PAYTON (LCSW, LMFT, ACSW)
Entity type:Individual
Prefix:MRS
First Name:VINNIE
Middle Name:PAYTON
Last Name:HOOVER
Suffix:
Gender:F
Credentials:LCSW, LMFT, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S. 36TH STREET, SUITE C
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5044
Mailing Address - Country:US
Mailing Address - Phone:918-682-9103
Mailing Address - Fax:918-682-9104
Practice Address - Street 1:211 S. 36TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5044
Practice Address - Country:US
Practice Address - Phone:918-682-9103
Practice Address - Fax:918-682-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4371041C0700X
OK443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100716360AMedicaid