Provider Demographics
NPI:1710270418
Name:DEANDRE LAJUAN RHODES
Entity Type:Organization
Organization Name:DEANDRE LAJUAN RHODES
Other - Org Name:DEON
Other - Org Type:Other Name
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEANDRE
Authorized Official - Middle Name:LAJUAN
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:918-850-2412
Mailing Address - Street 1:5010 S URBANA AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1737 E. 32ND ST. NORTH
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110
Practice Address - Country:US
Practice Address - Phone:918-428-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK61573931251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health