Provider Demographics
NPI:1407152002
Name:PRATHER, VASHETA LAVEN
Entity Type:Individual
Prefix:
First Name:VASHETA
Middle Name:LAVEN
Last Name:PRATHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 N MIDWEST BLVD
Mailing Address - Street 2:3
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3255
Mailing Address - Country:US
Mailing Address - Phone:405-532-0888
Mailing Address - Fax:
Practice Address - Street 1:3033 NW 63RD ST
Practice Address - Street 2:SUITE E-200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3634
Practice Address - Country:US
Practice Address - Phone:405-254-5228
Practice Address - Fax:888-688-7013
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor