Provider Demographics
NPI:1639409378
Name:DECKER, DEBBIE JEAN (MS, LBP)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:JEAN
Last Name:DECKER
Suffix:
Gender:F
Credentials:MS, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42631 TIMBER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940-3625
Mailing Address - Country:US
Mailing Address - Phone:918-653-7754
Mailing Address - Fax:
Practice Address - Street 1:3111 B N BROADWAY
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953
Practice Address - Country:US
Practice Address - Phone:918-647-2262
Practice Address - Fax:918-647-2282
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200123440AMedicaid