Provider Demographics
NPI:1497002752
Name:DEWBERRY, LAMAR
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:
Last Name:DEWBERRY
Suffix:
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 1:1700 KICKINGBIRD RD APT 1771
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6257
Mailing Address - Country:US
Mailing Address - Phone:405-210-8721
Mailing Address - Fax:
Practice Address - Street 1:1700 KICKINGBIRD RD APT 1771
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6257
Practice Address - Country:US
Practice Address - Phone:405-210-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health