Provider Demographics
NPI:1649605643
Name:DEAN, DELLA M (BHRS)
Entity type:Individual
Prefix:MS
First Name:DELLA
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-3107
Mailing Address - Country:US
Mailing Address - Phone:405-820-7085
Mailing Address - Fax:405-962-1639
Practice Address - Street 1:401 NW 79TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-3107
Practice Address - Country:US
Practice Address - Phone:405-820-7085
Practice Address - Fax:405-962-1639
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK271030381Medicaid
OK271030381Medicaid