Provider Demographics
NPI:1114296258
Name:CALDWELL, KAMEELAH DESHAWN
Entity Type:Individual
Prefix:
First Name:KAMEELAH
Middle Name:DESHAWN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 NW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-5012
Mailing Address - Country:US
Mailing Address - Phone:405-204-4763
Mailing Address - Fax:
Practice Address - Street 1:1015 WATERWOOD PKWY STE G-B2
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5355
Practice Address - Country:US
Practice Address - Phone:405-844-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst