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NPI Code Detail

MEDICARE: MS. DEBRA LYNN SPEARS

MEDICARE:  MS. DEBRA LYNN SPEARS
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
1101Y00000XCounselor
2103K00000XBehavior Analyst
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1932734431
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBRA LYNN SPEARS
Provider Business Mailing Address
First Line : PO BOX 23092
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73123-2092
Country : US
Telephone Number : 405-401-9266
Fax Number :
Provider Business Practice Location Address
First Line : 4605 W NICKLAS AVE APT B
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73132-6913
Country : US
Telephone Number : 405-401-9266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2020
Last Update Date : 03/05/2020

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Directions to “ MS. DEBRA LYNN SPEARS ” Practice Location

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