Provider Demographics
NPI:1174405377
Name:DAVES, ANGEL RALYN
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:RALYN
Last Name:DAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 LLEYTON DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2069
Mailing Address - Country:US
Mailing Address - Phone:661-472-4250
Mailing Address - Fax:
Practice Address - Street 1:3919 LLEYTON DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2069
Practice Address - Country:US
Practice Address - Phone:661-472-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician