Provider Demographics
NPI:1053594945
Name:SLENTZ, GEORGIA M (LCSW)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:M
Last Name:SLENTZ
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 1:13213 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1809
Mailing Address - Country:US
Mailing Address - Phone:405-848-0292
Mailing Address - Fax:405-755-5544
Practice Address - Street 1:13213 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1809
Practice Address - Country:US
Practice Address - Phone:405-848-0292
Practice Address - Fax:405-755-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical