Provider Demographics
NPI:1942643580
Name:AZEBBAR, PATRICE DENICE
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:DENICE
Last Name:AZEBBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICE
Other - Middle Name:DENICE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4325 MEADOWPARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7024
Mailing Address - Country:US
Mailing Address - Phone:405-886-4972
Mailing Address - Fax:
Practice Address - Street 1:4325 MEADOWPARK DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7024
Practice Address - Country:US
Practice Address - Phone:405-886-4972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst