Healthcare Provider Details

I. General information

NPI: 1518231257
Provider Name (Legal Business Name): REBECCA LEA DAMRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NW 50TH ST
OKLAHOMA CITY OK
73118-6001
US

IV. Provider business mailing address

801 NW 50TH ST
OKLAHOMA CITY OK
73118-6001
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-6638
  • Fax:
Mailing address:
  • Phone: 405-842-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: