Provider Demographics
NPI:1023390002
Name:RUPP, DEBRA S (MSED, LADC UNDERSUP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:S
Last Name:RUPP
Suffix:
Gender:F
Credentials:MSED, LADC UNDERSUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 580700
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74158
Mailing Address - Country:US
Mailing Address - Phone:918-430-0975
Mailing Address - Fax:918-430-0995
Practice Address - Street 1:2442 MOHAWK BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-1519
Practice Address - Country:US
Practice Address - Phone:918-430-0975
Practice Address - Fax:918-430-0995
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OKLADC1001101YA0400X
OKLPC5017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1104049733Medicaid