Provider Demographics
NPI:1841504685
Name:GILES KEITH, DODIE A
Entity type:Individual
Prefix:
First Name:DODIE
Middle Name:A
Last Name:GILES KEITH
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 1:36488 S HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-7438
Mailing Address - Country:US
Mailing Address - Phone:918-919-9529
Mailing Address - Fax:918-542-7778
Practice Address - Street 1:33 C STREET NORTHEAST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-540-1563
Practice Address - Fax:918-542-7778
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100732380C101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor