1164753604 NPI number — DONNA DANELLE MAGNESS MS, LPC CANDIDATE

Table of content: DONNA DANELLE MAGNESS MS, LPC CANDIDATE (NPI 1164753604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164753604 NPI number — DONNA DANELLE MAGNESS MS, LPC CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGNESS
Provider First Name:
DONNA
Provider Middle Name:
DANELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC CANDIDATE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAGNESS
Provider Other First Name:
DANELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPC CANDIDATE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1164753604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLEY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74829-0218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-667-3367
Provider Business Mailing Address Fax Number:
918-667-3387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RT 1, BOX 35D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLEY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-667-3367
Provider Business Practice Location Address Fax Number:
918-667-3387
Provider Enumeration Date:
01/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100685660A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100685660D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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