Provider Demographics
NPI:1134509540
Name:HABEN, ANNETTE (LADC-MH CANDIDATE)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:HABEN
Suffix:
Gender:F
Credentials:LADC-MH CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4520
Mailing Address - Country:US
Mailing Address - Phone:405-605-8488
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109
Practice Address - Country:US
Practice Address - Phone:405-605-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1134509540Medicaid