Basic Information
Provider Information
NPI: 1184847311
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: DEANA
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4436 NW 50TH ST
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731122212
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4436 NW 50TH ST
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731122212
CountryCode: US
TelephoneNumber: 4058582800
FaxNumber: 4058582880
Other Information
ProviderEnumerationDate: 04/10/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X2951OKY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home