Provider Demographics
NPI:1568733293
Name:MCDANIEL, DIANNE ROSS
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:ROSS
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N EVEREST AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1412
Mailing Address - Country:US
Mailing Address - Phone:405-235-7949
Mailing Address - Fax:
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-879-3443
Practice Address - Fax:405-879-3446
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional