Provider Demographics
NPI:1447955968
Name:WINTER, GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WINTER
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 1:100 NE 4TH ST APT 2403
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-2010
Mailing Address - Country:US
Mailing Address - Phone:405-924-2512
Mailing Address - Fax:
Practice Address - Street 1:2801 KENSINGTON TER
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6511
Practice Address - Country:US
Practice Address - Phone:405-924-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical