Healthcare Provider Details

I. General information

NPI: 1730200692
Provider Name (Legal Business Name): DANDRA KAYE RENTIE LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 NW 5TH STREET
MOORE OK
73160
US

IV. Provider business mailing address

P.O. BOX 5062
NORMAN OK
73070-5062
US

V. Phone/Fax

Practice location:
  • Phone: 405-912-3871
  • Fax: 405-799-0912
Mailing address:
  • Phone: 405-447-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC--603
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLADC--603
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: