Provider Demographics
NPI:1689099731
Name:GRANT, ANGELA DONNELL
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DONNELL
Last Name:GRANT
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 1:19174 S 201ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:OK
Mailing Address - Zip Code:74436-2239
Mailing Address - Country:US
Mailing Address - Phone:918-231-0369
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 707
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4537
Practice Address - Country:US
Practice Address - Phone:405-631-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor