Provider Demographics
NPI:1164753604
Name:MAGNESS, DONNA DANELLE (MS, LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:DANELLE
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:DANELLE
Other - Middle Name:
Other - Last Name:MAGNESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC CANDIDATE
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:BOLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74829-0218
Mailing Address - Country:US
Mailing Address - Phone:918-667-3367
Mailing Address - Fax:918-667-3387
Practice Address - Street 1:RT 1, BOX 35D
Practice Address - Street 2:
Practice Address - City:BOLEY
Practice Address - State:OK
Practice Address - Zip Code:74829
Practice Address - Country:US
Practice Address - Phone:918-667-3367
Practice Address - Fax:918-667-3387
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100685660AMedicaid
OK100685660DMedicaid