Provider Demographics
NPI:1639458037
Name:WAITERS, DAVID STEPHON
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:STEPHON
Last Name:WAITERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W HEFNER RD APT 205
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5813
Mailing Address - Country:US
Mailing Address - Phone:405-470-4402
Mailing Address - Fax:
Practice Address - Street 1:5757 W HEFNER RD APT 205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-5813
Practice Address - Country:US
Practice Address - Phone:405-470-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health