Provider Demographics
NPI:1407245582
Name:DEAN, THEA
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:DEAN
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:OK
Mailing Address - Zip Code:74866-0001
Mailing Address - Country:US
Mailing Address - Phone:405-534-7633
Mailing Address - Fax:
Practice Address - Street 1:214 E OAK AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3442
Practice Address - Country:US
Practice Address - Phone:405-382-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional