Provider Demographics
NPI:1477856136
Name:GUION-COLBERT, DORETHA MARIE (CERT IN CASE MGT)
Entity Type:Individual
Prefix:MRS
First Name:DORETHA
Middle Name:MARIE
Last Name:GUION-COLBERT
Suffix:
Gender:F
Credentials:CERT IN CASE MGT
Other - Prefix:DR
Other - First Name:DORETHA
Other - Middle Name:MARIE
Other - Last Name:GUION-COLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ED,D
Mailing Address - Street 1:3305 E FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-2225
Mailing Address - Country:US
Mailing Address - Phone:405-424-8352
Mailing Address - Fax:405-424-1624
Practice Address - Street 1:3305 E FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-2225
Practice Address - Country:US
Practice Address - Phone:405-424-8352
Practice Address - Fax:405-424-1624
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21042171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator