Provider Demographics
NPI:1174651707
Name:DEMARAIS, CHARLOTTE LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:LORRAINE
Last Name:DEMARAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:LORRAINE
Other - Last Name:PRESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-0000
Mailing Address - Country:US
Mailing Address - Phone:918-289-0550
Mailing Address - Fax:918-289-0551
Practice Address - Street 1:6301 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6103
Practice Address - Country:US
Practice Address - Phone:918-289-0550
Practice Address - Fax:918-289-0551
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health