Provider Demographics
NPI:1609193168
Name:TENNYSON, RUE LA SHELLE
Entity Type:Individual
Prefix:MRS
First Name:RUE
Middle Name:LA SHELLE
Last Name:TENNYSON
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 1:15017 KYLE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6513
Mailing Address - Country:US
Mailing Address - Phone:405-816-2276
Mailing Address - Fax:
Practice Address - Street 1:3005 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3603
Practice Address - Country:US
Practice Address - Phone:405-521-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health