Provider Demographics
NPI:1558635706
Name:ROUNDS, LAVONNE LEE (MED)
Entity Type:Individual
Prefix:
First Name:LAVONNE
Middle Name:LEE
Last Name:ROUNDS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LAVONNE
Other - Middle Name:LEE
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 279
Mailing Address - Street 2:
Mailing Address - City:FORT COBB
Mailing Address - State:OK
Mailing Address - Zip Code:73038-9775
Mailing Address - Country:US
Mailing Address - Phone:405-850-4867
Mailing Address - Fax:405-247-2091
Practice Address - Street 1:101 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-9772
Practice Address - Country:US
Practice Address - Phone:405-247-6874
Practice Address - Fax:405-247-2091
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK364101YP2500X
OK639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist