Basic Information
| Provider Information | |||||||||
| NPI: | 1437781325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADGER | ||||||||
| FirstName: | LATONYA | ||||||||
| MiddleName: | DEONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 639 BATES RD | ||||||||
| Address2: | |||||||||
| City: | FRIERSON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710272016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073505523 | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 SW 38TH ST | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802485780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2020 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | OK | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.