Provider Demographics
NPI:1952777344
Name:MANN, ROBERT ELLIS (RN, LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELLIS
Last Name:MANN
Suffix:
Gender:M
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, LSW
Mailing Address - Street 1:215 E HADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8716
Mailing Address - Country:US
Mailing Address - Phone:405-474-0988
Mailing Address - Fax:
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-456-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical