Provider Demographics
NPI:1982607644
Name:OKON, DEBORAH MCNEIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MCNEIL
Last Name:OKON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W REINKEN AVE
Mailing Address - Street 2:STE C
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-4257
Mailing Address - Country:US
Mailing Address - Phone:505-861-3894
Mailing Address - Fax:505-861-3897
Practice Address - Street 1:315 W REINKEN AVE
Practice Address - Street 2:STE C
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-4257
Practice Address - Country:US
Practice Address - Phone:505-861-3894
Practice Address - Fax:505-861-3897
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM264001103TS0200X
NM654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54002OtherPRESBYTERIAN HEALTH PLAN
NMNL55OtherBLUE CROSS/BLUE SHIELD
NMP4668Medicaid