Provider Demographics
NPI:1679811624
Name:MANCE, RASHAWN T (BACHELOR GRADUATE)
Entity Type:Individual
Prefix:MR
First Name:RASHAWN
Middle Name:T
Last Name:MANCE
Suffix:
Gender:M
Credentials:BACHELOR GRADUATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 FEATHERSTONE RD
Mailing Address - Street 2:APT 408
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2105
Mailing Address - Country:US
Mailing Address - Phone:630-886-9931
Mailing Address - Fax:
Practice Address - Street 1:2609 FEATHERSTONE RD
Practice Address - Street 2:APT 408
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2105
Practice Address - Country:US
Practice Address - Phone:630-886-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM083224255103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)