Provider Demographics
NPI:1366607152
Name:MEDLOCK, ALEXIA KNOX (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALEXIA
Middle Name:KNOX
Last Name:MEDLOCK
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 1:1721 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8812
Mailing Address - Country:US
Mailing Address - Phone:918-804-9379
Mailing Address - Fax:
Practice Address - Street 1:1721 E 57TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-8812
Practice Address - Country:US
Practice Address - Phone:918-804-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical