Provider Demographics
NPI:1609205509
Name:LITTLES, WYNETTA
Entity Type:Individual
Prefix:MRS
First Name:WYNETTA
Middle Name:
Last Name:LITTLES
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 1:2421 W NEWTON CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-3023
Mailing Address - Country:US
Mailing Address - Phone:918-583-0532
Mailing Address - Fax:
Practice Address - Street 1:401 S BOSTON SUITE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103
Practice Address - Country:US
Practice Address - Phone:918-402-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2206412167Medicaid