Provider Demographics
NPI:1376986752
Name:MCCUNE, JUDY ANN
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:MENASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3913 HARTLINE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4305
Mailing Address - Country:US
Mailing Address - Phone:580-579-0448
Mailing Address - Fax:
Practice Address - Street 1:3913 HARTLINE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4305
Practice Address - Country:US
Practice Address - Phone:580-579-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor