Provider Demographics
NPI:1376941732
Name:JUAREZ, DANA (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:WEEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 N MAIN ST
Mailing Address - Street 2:C/O 300 N MAIN ST
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521
Mailing Address - Country:US
Mailing Address - Phone:843-476-8385
Mailing Address - Fax:
Practice Address - Street 1:2100 N LOUIS TITTLE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:580-706-2439
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK1350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100739030AMedicaid