Provider Demographics
NPI:1639489420
Name:ABRAM, DARNELL JR
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:
Last Name:ABRAM
Suffix:JR
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 1:5308 N WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-7031
Mailing Address - Country:US
Mailing Address - Phone:405-248-2116
Mailing Address - Fax:
Practice Address - Street 1:5308 N WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-7031
Practice Address - Country:US
Practice Address - Phone:405-248-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKK004715598Medicaid