Provider Demographics
NPI:1710263892
Name:SYRUS, LORETTA FAYE
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:FAYE
Last Name:SYRUS
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 1:2605 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7654
Mailing Address - Country:US
Mailing Address - Phone:405-808-1720
Mailing Address - Fax:
Practice Address - Street 1:2605 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7654
Practice Address - Country:US
Practice Address - Phone:405-808-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor