Basic Information
Provider Information
NPI: 1598957201
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RHODES
FirstName: DANIEL
MiddleName: HALBERT
NamePrefix: MR.
NameSuffix:  
Credential: MSW, LCSWP
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: 4052722733
FaxNumber:  
Practice Location
Address1: 550 24TH AVE NW STE E
Address2:  
City: NORMAN
State: OK
PostalCode: 730696210
CountryCode: US
TelephoneNumber: 4053293349
FaxNumber: 4053643519
Other Information
ProviderEnumerationDate: 08/16/2007
LastUpdateDate: 08/16/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X3445-POKY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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