Basic Information
| Provider Information | |||||||||
| NPI: | 1912323254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGLADE | ||||||||
| FirstName: | CASSANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 WYLIE RD | ||||||||
| Address2: | 188 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730725949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462626666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 W GRAY ST | ||||||||
| Address2: | UNIT 140 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730697129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059196821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2014 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 103K00000X | OK | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.