Provider Demographics
NPI:1376848283
Name:LCDA
Entity type:Organization
Organization Name:LCDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER, BHRS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:405-601-8075
Mailing Address - Street 1:420 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-5610
Mailing Address - Country:US
Mailing Address - Phone:405-236-0701
Mailing Address - Fax:
Practice Address - Street 1:2624 N ANN ARBOR AVE APT 209
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-1805
Practice Address - Country:US
Practice Address - Phone:405-601-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management