Provider Demographics
NPI:1114442092
Name:RAINWATER, CAROLYN J
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1732
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-1732
Mailing Address - Country:US
Mailing Address - Phone:580-630-4229
Mailing Address - Fax:580-630-4229
Practice Address - Street 1:83 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:LONE GROVE
Practice Address - State:OK
Practice Address - Zip Code:73443-6443
Practice Address - Country:US
Practice Address - Phone:580-630-4229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health