Healthcare Provider Details

I. General information

NPI: 1982607644
Provider Name (Legal Business Name): DEBORAH MCNEIL OKON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W REINKEN AVE STE C
BELEN NM
87002-4257
US

IV. Provider business mailing address

315 W REINKEN AVE STE C
BELEN NM
87002-4257
US

V. Phone/Fax

Practice location:
  • Phone: 505-861-3894
  • Fax: 505-861-3897
Mailing address:
  • Phone: 505-861-3894
  • Fax: 505-861-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number264001
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number654
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: