Provider Demographics
NPI:1144743725
Name:EGHTESAD, DEBORAH (LPC-U)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:EGHTESAD
Suffix:
Gender:F
Credentials:LPC-U
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:HAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11911 S REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4384
Mailing Address - Country:US
Mailing Address - Phone:417-260-1980
Mailing Address - Fax:479-750-4843
Practice Address - Street 1:101 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1444
Practice Address - Country:US
Practice Address - Phone:918-599-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator