Provider Demographics
NPI:1386996163
Name:DUPLISSEY, DANIELLE RENEE (BHRS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:DUPLISSEY
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 SHADE TREE LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-8101
Mailing Address - Country:US
Mailing Address - Phone:918-635-5135
Mailing Address - Fax:918-647-2191
Practice Address - Street 1:23077 SHADE TREE LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-8101
Practice Address - Country:US
Practice Address - Phone:918-635-5135
Practice Address - Fax:918-647-2191
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor