Provider Demographics
NPI:1205157302
Name:DONETI, JOHN M (LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DONETI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NW 22ND ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1402
Mailing Address - Country:US
Mailing Address - Phone:405-427-0312
Mailing Address - Fax:
Practice Address - Street 1:600 NW 22ND ST
Practice Address - Street 2:SUITE 108
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1402
Practice Address - Country:US
Practice Address - Phone:405-427-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1227101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK27-2368634Medicaid