Provider Demographics
NPI:1649562810
Name:ADELEYE, VIVIEN
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:
Last Name:ADELEYE
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 1:10308 S KLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2970
Mailing Address - Country:US
Mailing Address - Phone:405-412-2975
Mailing Address - Fax:
Practice Address - Street 1:900 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7220
Practice Address - Country:US
Practice Address - Phone:405-528-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional