Provider Demographics
NPI:1952600785
Name:SPIRES, DERELL JOVAN
Entity type:Individual
Prefix:
First Name:DERELL
Middle Name:JOVAN
Last Name:SPIRES
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 1:9242 N MACARTHUR BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2451
Mailing Address - Country:US
Mailing Address - Phone:870-995-0919
Mailing Address - Fax:
Practice Address - Street 1:9242 NORTH MCARTHUR BLVD APT A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132
Practice Address - Country:US
Practice Address - Phone:870-995-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health