Provider Demographics
NPI:1912104191
Name:OPALEYE, BENJAMIN O
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:O
Last Name:OPALEYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7317 99TH EAST AVE
Mailing Address - Street 2:APT 1735
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3245
Mailing Address - Country:US
Mailing Address - Phone:918-852-0872
Mailing Address - Fax:
Practice Address - Street 1:323 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5019
Practice Address - Country:US
Practice Address - Phone:918-756-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health