Provider Demographics
NPI:1861694523
Name:BROCKWELL, ELIZABETH PAGE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAGE
Last Name:BROCKWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 WARNER AVE
Mailing Address - Street 2:#Q237
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4773
Mailing Address - Country:US
Mailing Address - Phone:714-517-6318
Mailing Address - Fax:
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-3700
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 283481041C0700X
OK58681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical