Provider Demographics
NPI:1437433687
Name:DEJEAR, MARSHALL LEO II
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:LEO
Last Name:DEJEAR
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6550
Mailing Address - Country:US
Mailing Address - Phone:918-752-4341
Mailing Address - Fax:918-756-2233
Practice Address - Street 1:601 CREEK DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6550
Practice Address - Country:US
Practice Address - Phone:918-752-4341
Practice Address - Fax:918-756-2233
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor