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General NPI Number Information
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NPI Number | 1467783779
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Entity Type | Individual
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Provider Name | DONALD DEAN RILEY CM
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Gender | Male
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 2405 NW 112TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-7202
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Country | US
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Telephone | 405-474-9670
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 NW 112TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-7202
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Country | US
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Telephone | 405-474-9670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 8717
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License Number State | OK
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