Healthcare Provider Details

I. General information

NPI: 1518169606
Provider Name (Legal Business Name): DEANA MARIE THARP M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 S. COMMERCE ST.
ARDMORE OK
73402-0189
US

IV. Provider business mailing address

PO BOX 189
ARDMORE OK
73402-0189
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-5070
  • Fax: 580-226-5617
Mailing address:
  • Phone: 580-223-5070
  • Fax: 580-226-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12938
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1391
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: