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NPI Code Detail

MEDICARE: DEREK T HODGES

MEDICARE: DEREK T HODGES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528349172
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK T HODGES
Provider Business Mailing Address
First Line : 4232 N SANTA FE AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-8517
Country : US
Telephone Number : 405-231-3150
Fax Number :
Provider Business Practice Location Address
First Line : 4232 N SANTA FE AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-8517
Country : US
Telephone Number : 405-231-3150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2011
Last Update Date : 09/08/2011

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