Provider Demographics
NPI:1689991085
Name:HART, CANDICE LEIGH (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:LEIGH
Last Name:HART
Suffix:
Gender:
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S LITTLE AVE APT B104
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4841
Mailing Address - Country:US
Mailing Address - Phone:918-908-0823
Mailing Address - Fax:
Practice Address - Street 1:1428 S LITTLE AVE APT B104
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4841
Practice Address - Country:US
Practice Address - Phone:918-908-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK108211175T00000X
225400000X
OK310698251B00000X
OK10615101YP2500X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No175T00000XOther Service ProvidersPeer Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200555170AMedicaid
OK200555170BMedicaid
OK310698Medicaid