Healthcare Provider Details

I. General information

NPI: 1710329974
Provider Name (Legal Business Name): MRS. REINA IVONNE ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 NW EXPRESSWAY SUITE 200
OKLAHOMA CITY OK
73112-5474
US

IV. Provider business mailing address

4516 NW 12TH ST
OKLAHOMA CITY OK
73127-4008
US

V. Phone/Fax

Practice location:
  • Phone: 405-543-2603
  • Fax:
Mailing address:
  • Phone: 405-473-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: