Provider Demographics
NPI:1306147830
Name:TETTEH, MAVIS ELEONORA (BS, RN)
Entity type:Individual
Prefix:MS
First Name:MAVIS
Middle Name:ELEONORA
Last Name:TETTEH
Suffix:
Gender:F
Credentials:BS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BLAKE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4386
Mailing Address - Country:US
Mailing Address - Phone:405-285-0524
Mailing Address - Fax:405-285-0524
Practice Address - Street 1:709 BLAKE CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4386
Practice Address - Country:US
Practice Address - Phone:405-285-0524
Practice Address - Fax:405-285-0524
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health