Provider Demographics
NPI:1780299065
Name:COON, DESIREA (BSW)
Entity type:Individual
Prefix:MS
First Name:DESIREA
Middle Name:
Last Name:COON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-3140
Mailing Address - Country:US
Mailing Address - Phone:405-584-7405
Mailing Address - Fax:
Practice Address - Street 1:429 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7019
Practice Address - Country:US
Practice Address - Phone:405-275-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker