Provider Demographics
NPI:1255459889
Name:DENISE LAGRAND, PSY.D., LLC
Entity type:Organization
Organization Name:DENISE LAGRAND, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LAGRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:918-931-9600
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1247
Mailing Address - Country:US
Mailing Address - Phone:918-931-9600
Mailing Address - Fax:918-456-8773
Practice Address - Street 1:411 W CHICKASAW ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4301
Practice Address - Country:US
Practice Address - Phone:918-931-9600
Practice Address - Fax:918-456-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04-1P103TC0700X
AK533103TC0700X
OK727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty