MEDICARE: DONELL L HOUTS LSCW

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
1	1041C0700X	Clinical Social Worker	2270	OK

General Provider Information

NPI Number	:	1770713505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONELL L HOUTS LSCW

Provider Business Mailing Address
First Line	:	1916 NW 42ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2232
Country	:	US
Telephone Number	:	405-213-6678
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 NW 42ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2232
Country	:	US
Telephone Number	:	405-213-6678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	04/04/2011

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