Provider Demographics
NPI:1215410840
Name:BELL, DE NESHA DO'NAI
Entity type:Individual
Prefix:
First Name:DE NESHA
Middle Name:DO'NAI
Last Name:BELL
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 1:2429 N QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4043
Mailing Address - Country:US
Mailing Address - Phone:918-718-7828
Mailing Address - Fax:
Practice Address - Street 1:3916 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1509
Practice Address - Country:US
Practice Address - Phone:918-392-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102X00000X, 103TA0700X, 174H00000X, 101YA0400X
OKS083566551172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No172A00000XOther Service ProvidersDriver
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKB12826196Medicaid