Provider Demographics
NPI:1285815118
Name:TODD, DESHAWNA OLIVIA (BA)
Entity Type:Individual
Prefix:MRS
First Name:DESHAWNA
Middle Name:OLIVIA
Last Name:TODD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:DESHAWNA
Other - Middle Name:OLIVIA
Other - Last Name:HAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1622 GLENNAN DR
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-7601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1622 GLENNAN DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-7601
Practice Address - Country:US
Practice Address - Phone:405-514-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor