Provider Demographics
NPI:1376889378
Name:MOSLANDER, DEANNA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:BETH
Last Name:MOSLANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 5TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2658
Mailing Address - Country:US
Mailing Address - Phone:405-212-7348
Mailing Address - Fax:405-265-2553
Practice Address - Street 1:110 S 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2658
Practice Address - Country:US
Practice Address - Phone:405-212-7348
Practice Address - Fax:405-265-2553
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200488480BMedicaid