Provider Demographics
NPI:1750632261
Name:ASBERRY, LAQUISHA
Entity Type:Individual
Prefix:MISS
First Name:LAQUISHA
Middle Name:
Last Name:ASBERRY
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 1:2764 S 136TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-2660
Mailing Address - Country:US
Mailing Address - Phone:918-237-9308
Mailing Address - Fax:
Practice Address - Street 1:2764 S 136TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-2660
Practice Address - Country:US
Practice Address - Phone:918-237-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200287120AMedicare Oscar/Certification