Basic Information
| Provider Information | |||||||||
| NPI: | 1043530827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROVOST | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | BSW/MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5092 S HICKORY AVE | ||||||||
| Address2: | |||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740114662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188509081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12005 E 470 RD | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740173737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183740770 | ||||||||
| FaxNumber: | 9183420087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 08/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.