Healthcare Provider Details

I. General information

NPI: 1396337069
Provider Name (Legal Business Name): ELAINE DEMKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NW EXPRESSWAY STE 450
OKLAHOMA CITY OK
73118-1849
US

IV. Provider business mailing address

1900 NW EXPRESSWAY STE 450
OKLAHOMA CITY OK
73118-1849
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-7982
  • Fax: 405-849-9164
Mailing address:
  • Phone: 405-604-7982
  • Fax: 405-849-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELAINE DEMKE
Title or Position: OWNER
Credential: M.S. LMFT
Phone: 405-604-7982