Provider Demographics
NPI:1356672422
Name:PILGRIM, DEANA LAVERNE (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:DEANA
Middle Name:LAVERNE
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5300
Mailing Address - Country:US
Mailing Address - Phone:918-421-8880
Mailing Address - Fax:918-421-8929
Practice Address - Street 1:106 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5300
Practice Address - Country:US
Practice Address - Phone:918-421-8880
Practice Address - Fax:918-421-8929
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200380750BMedicaid
OK200380750AMedicaid