Provider Demographics
NPI:1891031456
Name:RUNNELS, DONALD L JR
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:RUNNELS
Suffix:JR
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 1:115 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3801
Mailing Address - Country:US
Mailing Address - Phone:402-541-8974
Mailing Address - Fax:
Practice Address - Street 1:115 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3801
Practice Address - Country:US
Practice Address - Phone:402-541-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional