Provider Demographics
NPI:1134548670
Name:DEROUSSELLE, FELIX J
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:J
Last Name:DEROUSSELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 N BLACKWELDER AVE
Mailing Address - Street 2:APT 120
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2008
Mailing Address - Country:US
Mailing Address - Phone:405-850-6460
Mailing Address - Fax:405-601-4579
Practice Address - Street 1:310 NE 28TH ST
Practice Address - Street 2:SUTE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2806
Practice Address - Country:US
Practice Address - Phone:405-601-4565
Practice Address - Fax:405-601-4579
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor