Provider Demographics
NPI:1295254910
Name:RAGLAND, AMANDA OAVA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:OAVA
Last Name:RAGLAND
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 1:600 W INDEPENDENCE ST STE 900
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4320
Mailing Address - Country:US
Mailing Address - Phone:405-765-9815
Mailing Address - Fax:
Practice Address - Street 1:600 W INDEPENDENCE ST STE 900
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4320
Practice Address - Country:US
Practice Address - Phone:405-765-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor