Provider Demographics
NPI:1174640700
Name:LAGRAND, DENISE MICHELE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MICHELE
Last Name:LAGRAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1247
Mailing Address - Country:US
Mailing Address - Phone:918-931-9600
Mailing Address - Fax:918-456-8773
Practice Address - Street 1:411 W CHICKASAW ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4301
Practice Address - Country:US
Practice Address - Phone:918-931-9600
Practice Address - Fax:918-456-8773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK727103TC0700X
AR04-1P103TC0700X
AK533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical