Provider Demographics
NPI:1306121785
Name:MUSGRAVES, DENA
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:MUSGRAVES
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 1:19850 CR 1680
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:OK
Mailing Address - Zip Code:74871
Mailing Address - Country:US
Mailing Address - Phone:817-229-4757
Mailing Address - Fax:
Practice Address - Street 1:19850 CR 1680
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:OK
Practice Address - Zip Code:74871
Practice Address - Country:US
Practice Address - Phone:817-229-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst