Provider Demographics
NPI:1851797393
Name:DUPRE CASANOVA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DUPRE CASANOVA
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 1:1410 E 38TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3354
Mailing Address - Country:US
Mailing Address - Phone:214-577-9738
Mailing Address - Fax:
Practice Address - Street 1:1410 E 38TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3354
Practice Address - Country:US
Practice Address - Phone:214-577-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional