Provider Demographics
NPI:1205190949
Name:CROOK, DANETTA
Entity Type:Individual
Prefix:
First Name:DANETTA
Middle Name:
Last Name:CROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 S BOULDER AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-5234
Mailing Address - Country:US
Mailing Address - Phone:918-585-1213
Mailing Address - Fax:918-585-1263
Practice Address - Street 1:1870 S BOULDER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5234
Practice Address - Country:US
Practice Address - Phone:918-585-1213
Practice Address - Fax:918-585-1263
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor