Provider Demographics
NPI:1093137713
Name:TAKANG, RENE
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:TAKANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TEALWOOD DR APT 1513
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1786
Mailing Address - Country:US
Mailing Address - Phone:770-906-1744
Mailing Address - Fax:
Practice Address - Street 1:5929 N MAY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3909
Practice Address - Country:US
Practice Address - Phone:770-906-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor