Provider Demographics
NPI:1508170044
Name:HEATH, DEAN
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:HEATH
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 1:7525 S 95TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5273
Mailing Address - Country:US
Mailing Address - Phone:918-510-7774
Mailing Address - Fax:918-286-3914
Practice Address - Street 1:7525 S 95TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5273
Practice Address - Country:US
Practice Address - Phone:918-510-7774
Practice Address - Fax:918-286-3914
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health