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General NPI Number Information
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NPI Number | 1750940110
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Entity Type | Individual
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Provider Name | DESIRAE ALLEN M.A.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 1721 W 33RD ST STE B
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City | EDMOND
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State | OK
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Zip | 73013-3834
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Country | US
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Telephone | 405-465-7584
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Fax |
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Provider Business Mailing Address
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Address Line | 5107 N HAMILTON DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5317
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Country | US
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Telephone | 580-465-5700
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OK
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