Provider Demographics
NPI:1922358233
Name:SOTO, MICHELLE RANEE (BA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RANEE
Last Name:SOTO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RANEE
Other - Last Name:DEWBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:15 MONROE ST NE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2025
Mailing Address - Country:US
Mailing Address - Phone:580-226-1838
Mailing Address - Fax:580-223-7856
Practice Address - Street 1:15 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2025
Practice Address - Country:US
Practice Address - Phone:580-226-1838
Practice Address - Fax:580-223-7856
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100709510A103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst