Provider Demographics
NPI:1922400902
Name:DECOTEAU, GINGER (MS, MED)
Entity Type:Individual
Prefix:MS
First Name:GINGER
Middle Name:
Last Name:DECOTEAU
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7227
Mailing Address - Country:US
Mailing Address - Phone:405-751-4219
Mailing Address - Fax:405-463-6635
Practice Address - Street 1:2525 NW EXPRESSWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7227
Practice Address - Country:US
Practice Address - Phone:405-751-4219
Practice Address - Fax:405-463-6635
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker