Provider Demographics
NPI:1639794852
Name:HOUSER, LEEANN DEBRA
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:DEBRA
Last Name:HOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:DEBRA
Other - Last Name:HOUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20580 GILMER RD
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-2182
Mailing Address - Country:US
Mailing Address - Phone:918-756-9250
Mailing Address - Fax:
Practice Address - Street 1:1803 S WOOD DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6825
Practice Address - Country:US
Practice Address - Phone:918-756-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty