Provider Demographics
NPI:1851631519
Name:RANEY, COREY ODELL
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ODELL
Last Name:RANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E RICHMOND TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4937
Mailing Address - Country:US
Mailing Address - Phone:405-664-0628
Mailing Address - Fax:
Practice Address - Street 1:3509 TECUMSEH DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4319
Practice Address - Country:US
Practice Address - Phone:405-664-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200253070-BMedicaid