Provider Demographics
NPI:1467783779
Name:RILEY, DONALD DEAN (CM)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DEAN
Last Name:RILEY
Suffix:
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 NW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7202
Mailing Address - Country:US
Mailing Address - Phone:405-474-9670
Mailing Address - Fax:
Practice Address - Street 1:2405 NW 112TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7202
Practice Address - Country:US
Practice Address - Phone:405-474-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8717101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor