Provider Demographics
NPI:1578882692
Name:PORTUGAL, GIOVANA (MASTERS)
Entity Type:Individual
Prefix:
First Name:GIOVANA
Middle Name:
Last Name:PORTUGAL
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S WARDS CHAPEL
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-4104
Mailing Address - Country:US
Mailing Address - Phone:580-380-1844
Mailing Address - Fax:
Practice Address - Street 1:1021 SW 128TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6951
Practice Address - Country:US
Practice Address - Phone:405-626-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor