Provider Demographics
NPI:1215269972
Name:DEAN, ARNELL (MS)
Entity type:Individual
Prefix:MR
First Name:ARNELL
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7932
Mailing Address - Country:US
Mailing Address - Phone:405-630-5076
Mailing Address - Fax:405-216-5272
Practice Address - Street 1:11320 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7932
Practice Address - Country:US
Practice Address - Phone:405-630-5076
Practice Address - Fax:405-216-5272
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200123000BMedicaid
OK200123000AMedicaid