Provider Demographics
NPI:1285366864
Name:POPP, DEBRA LYNETTE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNETTE
Last Name:POPP
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNETTE
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 W WASHBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-4205
Mailing Address - Country:US
Mailing Address - Phone:918-703-4805
Mailing Address - Fax:
Practice Address - Street 1:1015 W WASHBOURNE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-4205
Practice Address - Country:US
Practice Address - Phone:918-703-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator