Provider Demographics
NPI:1336411073
Name:LITTLE, LA FAWN N (BS)
Entity Type:Individual
Prefix:MRS
First Name:LA FAWN
Middle Name:N
Last Name:LITTLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 MICHAEL PL
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4557
Mailing Address - Country:US
Mailing Address - Phone:405-514-5946
Mailing Address - Fax:
Practice Address - Street 1:903 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2045
Practice Address - Country:US
Practice Address - Phone:405-514-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health