Basic Information
| Provider Information | |||||||||
| NPI: | 1467655381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUCKS | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | JON | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E MAIN | ||||||||
| Address2: | RESOURCE MANAGEMENT | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367211 | ||||||||
| FaxNumber: | 5802725757 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 CASINO AVE | ||||||||
| Address2: | BENEFITS DEPT | ||||||||
| City: | THACKERVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802725170 | ||||||||
| FaxNumber: | 5804218772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2265 | OK | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 2268 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.