Provider Demographics
NPI:1992024954
Name:DERBY, JUDEAN ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:JUDEAN
Middle Name:ELIZABETH
Last Name:DERBY
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:PO BOX 615
Mailing Address - Street 2:204 SE A
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0615
Mailing Address - Country:US
Mailing Address - Phone:580-239-9354
Mailing Address - Fax:
Practice Address - Street 1:204 SE A ST
Practice Address - Street 2:POB 615
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-4021
Practice Address - Country:US
Practice Address - Phone:580-239-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker