Provider Demographics
NPI:1710181631
Name:GUEVARA, NADIA (LADC)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11613 E 84TH CT N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2147
Mailing Address - Country:US
Mailing Address - Phone:918-376-9496
Mailing Address - Fax:
Practice Address - Street 1:11613 E 84TH CT N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2147
Practice Address - Country:US
Practice Address - Phone:918-376-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK577101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNAD1GUE2CROther1